BACKGROUND: Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL). METHODS: This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (n = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (n = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities > 85% of maximal heart rate. RESULTS: Attendance rate for the 3-months HIIT intervention was 68.0 +/- 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% versus 20.5%) and 12 months (26.5% versus 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD) 0.01, 95% confidence interval (CI) -0.09 to 0.12, p = 0.82) or 12 months (MD 0.06, CI -0.07 to 0.19, p = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI 0.17 to 0.06, p < 0.01) at 3 months and 0.20 (CI 0.26 to 0.14, p < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI 0.01 to 5.44, p = 0.05) in PedsQL Child total-score and 3.85 (CI 0.96 to 6.74, p < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI 10.97 to 2.83, p < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure. CONCLUSION: Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

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