Introduction: Overweight and obesity (SO) generate health problems and public spending that generate conditions such as diabetes and coronary heart disease at an early age and adolescents. Most exercise programs focus on weight reduction, however, does not explain how exercise manages to generate an effect on the emotions of the teenager who can positively impact the body weight loss. The aim of the study was to conduct a literature review to analyze the effect of exercise on the emotions of adolescents with SO. Methodology. The review was stuck to the PRISM

Methodology: EBSCOhost, Redalyc, Scielo, Science Direct, Pub Med, Medline APAsycnet VHL, Springer Link and SCOPUS: databases were reviewed. 2012-2018 year published articles based on exercise alone or combined with food and emotional behavior, making recommendations for the treatment of SO, with participants from 10 to 19 years old were included.

Results: 455 articles were found, 447 were removed for breach of inclusion criteria, leaving 8 items included and analyzed. 12.5% ​​of the articles were systematic reviews, clinical trials 75% and 12.5% ​​of association.

Conclusion: It is not sufficiently clarified how exercise affects the positive and negative emotions in adolescents with SO. The works presented are not free from methodological biases, or establish a specific dose of exercise to reduce negative emotions. Based on exercise alone or combined with food and emotional behavior, making recommendations for the treatment of SO, with participants from 10 to 19 years old.

Keywords: emotions, exercise, adolescents, obesity, overweight, systematic review

Worldwide, overweight and obesity represent a public health problem given the number of adolescents with these conditions increased by 50% over previous years.¹ According to the Pan American Health Organization,² overweight and obesity affect 20% to 25% of people under 19 years, respectively.

Health problems and public spending generated by these conditions have led to the creation of exercise programs for weight reduction, most specifically focused to combat the consequences of weight gain as insulin resistance, metabolic syndrome and lipotoxicity, precursors of type 2 diabetes, hypertension and coronary heart disease; diseases the leading cause of death are depicted in increasingly younger ages.^3–-9 However, most exercise programs in adolescents do not consider the emotional or affective changes for body weight control, it is unknown how the exercise can influence the psychological stability of these adolescents.¹⁰

The literature reports that the emotional and affective aspects may be of importance in the development of overweight and obesity in adolescents, because at this stage of life, behavior is variable, not fixed, so it is not clear how exercise contributes to stabilize negative emotions like depression, low self-esteem, the feeling of rejection or discrimination, anxiety, anger and boredom among others.

Hence the importance of developing exercise programs for weight loss, involving not only biological, but also the emotional or affective.^11–13 Some studies suggest deepen the understanding of the relationship between Body Mass Index (BMI) and emotions as a means to intervene later in this relationship.^14–17

In short, although overweight and obesity have been linked to emotional or affective aspects; literature has failed to explain how exercise manages to generate an effect on adolescent emotions that can reach a positive impact on body weight loss. The aim of the study was to conduct a literature review to analyze the effect of exercise in the various weight loss programs on the emotions of overweight and obese adolescents.

It stuck to review the methodology Preferent Reporting Items for Systematic Reviews and Meta-Analyzes.¹⁸ EBSCOhost, Redalyc, Scielo, Science Direct, Pub Med, Medline VHL, APAsycnet, Springer Link and SCOPUS: The following databases were reviewed. Search terms included the following key words obtained from the MeSH (Medical Subject Headings) and DeCS (Health Sciences Descriptors): "emotions", "exercise", "adolescent", "obesity", "overweight" "randomized clinical trial"; and the combination of these, using a specific search strategy. Searches were Spanish, English and Portuguese, during April 2017 and May 2018.

Published articles of association, systematic reviews, randomized clinical trials, based on exercise or in combination with diet and emotional behavior interventions, which make recommendations for the treatment of overweight and obesity, with participants between 10 and 19 years old with obesity were included and / or overweight and were published between 1 January 2012 until 28 May 2018.

The methodological process for systematic reviews developed in PRISMA guidelines are followed. The search was conducted in different databases selected and duplicates were removed manually. Two independent researchers conducted screening items by title and abstract, disagreements regarding the inclusion of items were resolved by consensus; then they analyzed in full text.

Each full-text article underwent an assessment of quality (consistency and plausibility of purpose, results and discussion) and risk of bias (compliance with criteria Consolidated Standards of Reporting Trials¹⁹ and compliance with criteria PRISMA, this allowed the assessment methodological aspects and the validity of the study.

455 items were found, 447 of these were removed due to non-inclusion criteria, inconsistencies and other reasons (invalid instruments reported); 8 items being included in total and analyzed in this study (Figure 1).

Figure 1 Flow chart of the process of selection and inclusion of items (PRISM).

General characteristics of the studies

12.5% ​​of the articles were systematic reviews, clinical trials 75% and 12.5% ​​of association. In the systematic review 28 articles, of which only 3 are taken into account psychological aspects in children and adolescents are included; in these different physical activity it is carried out over a period of 9 weeks to 2 years of follow-up, with an uptime of 45 to 75 minutes, also mentioned in an article of this review should be performed nutritional and psychological evaluation, all this in order to change the lifestyles of adolescents and promote self-control and self-efficacy.

In the longitudinal association study, exercise was associated with emotional regulation, self-efficacy to be physically active and self-efficacy for physical activity.

Clinical trials included interventions of aerobic exercise, anaerobic and the combination of both types of exercise. In addition, multidisciplinary interventions were made to enhance the effect of exercise interventions, among them are: nutritional counseling, cognitive-behavioral counseling to change unhealthy habits, medical examination and counseling.

The duration of the interventions was variable, from 4 weeks to 2 years; Sessions ranged from once a week to five times a week; the length of sessions ranged from 20 to 60 minutes.

The outcome variables were body weight, BMI, body fat percentage and waist circumference also most interventions showed improvements in emotional well-being, self-esteem, vigor, and decreased emotional role emotions such as anger and anxiety.

Limitations and possible sources of bias items are presented in relation to the study design, no inclusion of the influence of hormones by sex (androgens and estrogens) on weight gain, adherence to the prescription of exercise, lack of group control small samples, lack of tools to identify emotions, financing the study, differences between groups to compare due to the non-equivalence, difficulties in the role of facilitators in the intervention. Then the results of each item selected in the following table are presented to facilitate interpretation of each (Table 1).

The objective was to analyze the effect of exercise practiced in the various programs on the emotions of overweight and obese adolescents. It will be addressed by sections the content of each study used for this article, in the first section systematic reviews, experimental studies, randomized clinical trials with parallel group representative and calculated sample considered strengths to their results were prioritized more attached methodological processes and jobs that did not meet these situations are considered weaknesses, taking into account the criteria of the CONSORT and PRISMA. In the second section the type of intervention (aerobic exercise, gradual and progressive) will be observed. In the third section.

When performing the analysis of items we found that both Golfield, Melink, Recee, Lofrano-Prado, Freitas et al.,²⁰ used an experimental design, Rocha conducted a systematic review in which only 3 articles address emotional, emotional aspects of self-esteem, only Isasi et al.,²¹ used cross-associative design however suggests to conduct experimental studies to test the emotional regulation and exercise.

In reviewing the statement PRISMA found that Rocha provides a structured summary describes the rationale for the review in the context of what is already known about the issue, explicitly talks about the participants, interventions and study design does not indicate whether there is a protocol that can be accessed or registration number, specifies the characteristic of the studies describes all sources of information search as well as the last date of search performed, specifies how the selection was made studies, does not describe methods for extracting data not mentioned risk of bias in individual studies, additional analysis as to the results mentioned characteristics of individual studies,within the discussion of the evidence summary of the main findings, conclusions and limitations of the work is observed but does not show the sources of funding.

By matching the checklist of the information included in the study with experimental methodology,¹⁹ Lofrano-Prado, Melynk, Reece, Goldfield et al.^22–24,12 have a degree in which the experimental methodology identifies and present a good summary structured methods, results and conclusions. Regarding the content of the Golfield et al.¹² & Geertz et al.,²⁵ and scientific background Freitas mentioned introduction, explanation, reasoning and specification of objectives and hypotheses. For the methodology, Goldfield, Melink and Freitas described design study with parallel groups, including assigning to each group. Golfield, Geertz, Reece, Melynk, Prado and Freitas Lofrano-mentioned criteria for selecting participants. Golfield, Melink and Freitas They pointed out in detail the interventions for each group in order to replicate when and how they were actually administered. Golfield and Melynk dates mentioned the indicator periods of recruitment and follow-up .Únicamente Melynk determined the size of their sample was for power analysis according to literature. None of the studies clarified how it is that: your sample randomized, conducted hidden mechanisms of allocation and masking process. Goldfield and Melynk They pointed out in detail the procedures to allow replication, included when and how they were actually administered. Melynk only determined the size of the sample was by power analysis according to literature. None of the studies clarified how it is that: your sample randomized, conducted hidden mechanisms of allocation and masking process. Goldfield and Melynk They pointed out in detail the procedures to allow replication, included when and how they were actually administered. Melynk only determined the size of the sample was by power analysis according to literature. None of the studies clarified how it is that: your sample randomized, conducted hidden mechanisms of allocation and masking process. Goldfield and Melynk They pointed out in detail the procedures to allow replication, included when and how they were actually administered.²⁶

Another point to be analyzed by the checklist were the statistical methods which were used to compare the groups in the primary and secondary results.

Regarding the results Golfield, Geertz and Reece clearly defined evaluations prespecified primary outcomes and the secondary, including how and when evaluated, as well as the change in results after the study has begun. Golfield, Reece, Melynk, Lofrano-Prado and Freitas shown for each primary and secondary outcome, the results for each group and the effect size and precision (with a confidence interval 95%). Golfield and Reece indicate adverse effects and unwanted effects in each group.

About the discussion in the studies, all items covered by the limitations of the study, consider the sources of potential bias, generalize the study findings (external validity and applicability, interpret the results by balancing the effects of assumptions and have account other relevant evidence.

Other information provided by the studies are: registration number, access to study and funding. Golfield, Melynk, Lofrano-Prado mention your registration number and name of the study. Golfield, Geertz, Melynk, Lofrano-Prado and Freitas mentioned as protocol can be found to make it accessible. Golfield, Geertz, Melynk and Freitas mention their sources of funding and support.

To analyze interventions studies was evaluated studies counted with: parallel group, control group, masking, measurements and devices or measuring instruments, exercise dose, additional interventions to exercise, sample contamination and risk of bias.

Goldfield, Geertz Melynk and Freitas considered parallel groups. With respect to the control group only they have him Golfield, Lofrano-Prado, Melynk and Freitas. A close masking, Goldfield and Melynk using single-blind mention during his speech however none of the studies reported whether or not succeeded in masking process. Regarding measurements taken during the intervention: Reece, Lofrano-Prado and Melynk size measured by a stadimeter; Reece, Lofrano-Melynk Prado and weighed to adolescencentes with a scale or Filizola; Reece, Lofrano-Prado, Melink the calculated BMI. Percentage body was measured by Golfield and colleagues by magnetic and Lofrano-Prado measured by the bioelectrical impedance resonance; Geertz leg strength measured with a trainer leg Golfield Genius and measured pressing force and leg press; Golfield, Lofrano-Prado and Freitas measured ventilatory threshold and maximum oxygen to calculate the dose of exercise; Melynk took into account the number of steps per week to keep track of physical activity using a pedometer; Lofrano- Prado uses the Borg scale physical effort to monitor exercise intensity teenager. Intervention according to the researchers should last 20 to 60 minutes, averaging 40 minutes time, it is noteworthy that only Geertz, Reece and Melynk perform physical activities such as judo, hiking, dancing and kick boxing, all other studies use treadmills, ergometers, elliptical machines and free weights. Some additional physical activity interventions were: nutritional counseling as mentioned Golfield, Lofrano Prado, in addition to controlling Freitas kcal consumption ranging from 250 to 350 kcal it is provided by registered dietitians; Freitas also included interventions counseling and medical monitoring by an endocrinologist.

As for sample contamination none of the studies mentioned sample or if your sample was contaminated or had some risk. Some of the risks of bias in the studies were: small sample, no randomization of the sample, not taking into account hormones, fidelity intervention by facilitators and poorly implemented using questionnaires for the variable.

Another aspect to assess studies without doubt the most important of this review, arises from the following questions: Does exercise influence emotions?, Really studies specifically focus on emotions? On the one hand, according to the literature review studies do not refer to or mention that emotions improve the dose of exercise, as mentioned Goldfield and his collaborators changing psychological health is more closely associated with fat reduction body that changes in fitness or strength. It is unclear how that emotions are modified through an exercise intervention.

On the other hand the analyzed studies do not define emotions as a variable outcome, in other words many of these studies encompass emotions generally in concepts such as self-esteem, psychological well-being, symptoms of depression, psychological health, symptoms of anxiety, quality of life and emotional well-being.

According to the results that threw the literature review to analyze the effect of exercise on the emotions of adolescents with overweight and obesity, is not sufficiently clarified how exercise affects the positive and negative emotions, without englobarlas or sort together, plus programs have not been raised under an experimental methodology with parallel and controlled, with masked interventions and random selection of study subjects who meets the criteria checklist of the information included in a study methodology experimental (CONSORT 2010). The works presented are not free of methodological bias and a dose of specific exercise is not set to decrease negative emotions.

None.

The Author declares no conflict of interests.

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