An interventional study of Standard Exercise Intervention and Nudge-Based Exercise Intervention in Pediatric Obesity, sponsored by Nanjing Children's Hospital. Recruiting at 1 site in China. Open to participants aged 10 Years to 19 Years. Per ClinicalTrials.gov, last updated 2026-09-17.
Sponsored by Nanjing Children's Hospital · Not applicable, Interventional, and Treatment
This study will evaluate whether a nudge-based exercise program can improve body mass index (BMI) and physical activity in adolescents with obesity. About 140 adolescents aged 10-19 years will participate. Participants will be placed into one of two groups according to the order in which they are admitted to the hospital. One group will receive a standard exercise intervention, while the other group will receive an 8-week nudge-based exercise program designed to make regular physical activity easier to start and maintain.
The nudge-based program uses simple behavioral strategies to make exercise easier to start and maintain, including framed and visual information, default exercise options, reminders, peer comparison and support, goal commitment, progress feedback, and small incentives. The program combines face-to-face sessions during hospitalization with home-based support, exercise tools, activity recording, and online follow-up.
The main outcomes are changes in BMI and physical activity. Other outcomes include body composition, blood metabolic markers, health-related quality of life, and exercise self-efficacy. Assessments will be conducted before and after the intervention, with follow-up assessments used to examine whether the effects are maintained over time.
Exclusion Criteria:
Participants in this arm receive a standardized exercise intervention based on current clinical guidance. The program focuses on moderate-intensity aerobic exercise performed 3-4 times per week for 40-50 minutes per session. Participants also receive routine exercise-related health education and follow-up support.
Behavioral: Standard Exercise Intervention
Participants in this arm receive an 8-week nudge-based exercise intervention designed to promote the initiation and maintenance of physical activity. The intervention uses strategies including framed and visual information, social reference, default exercise options, reminders, commitment, progress feedback, and incentives. It combines structured face-to-face sessions during hospitalization with an exercise nudge package and home-based support through online reminders, activity recording, peer interaction, and incentives.
Behavioral: Nudge-Based Exercise Intervention
Participants receive a standardized exercise program based on current clinical guidance. The program primarily consists of moderate-intensity aerobic exercise performed 3-4 times per week for 40-50 minutes per session. Participants also receive routine exercise-related health education and regular follow-up support.
Participants receive an 8-week nudge-based exercise program designed to facilitate the initiation and maintenance of physical activity. The intervention incorporates framed and visual information, social reference, default exercise options, reduced effort for accessing exercise opportunities, reminders, commitment strategies, progress feedback, and incentives. During hospitalization, participants receive structured face-to-face sessions and an exercise nudge package containing exercise equipment, activity task cards, and a reminder device. After discharge, home-based support is provided through online exercise reminders, activity recording, peer interaction, progress feedback, and incentives.
Change in Body Mass Index (BMI)
Body weight and height will be measured at baseline and approximately 3 months after baseline. Weight in kilograms and height in meters will be combined to report a single BMI value using the formula: BMI = weight (kg) / \[height (m)\]\^2. Body weight and height are component measurements used to derive BMI for this endpoint and are not separate outcome measures. Change in BMI will be calculated as the BMI value at approximately 3 months after baseline minus the baseline BMI value. The reported unit of measure is kg/m\^2.
Time frame: Baseline and approximately 3 months after baseline
Change in Physical Activity
Physical activity will be assessed using the Chinese version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The questionnaire records walking, moderate-intensity, and vigorous-intensity physical activity during the previous 7 days. The activity-specific values will be converted to metabolic equivalent of task minutes per week (MET-minutes/week) and summed according to the IPAQ-SF scoring method to generate a single total physical activity score. The individual activity categories are components of the total score and are not separate outcome measures under this endpoint. Change in physical activity from baseline to the follow-up assessment will be evaluated.
Time frame: Baseline and approximately 3 months after baseline
Change in Total Sedentary Time
Sedentary behavior will be assessed using a questionnaire that records time spent in common sedentary activities outside school hours on each day of a typical week, including screen-based activities, homework and reading, tutoring, motorized transportation, sedentary hobbies, social activities, and playing musical instruments. Total sedentary time will be summarized as average minutes per day. Change from baseline to follow-up will be evaluated.
Time frame: Baseline and approximately 3 months after baseline
Change in Body Fat Percentage
Body fat percentage will be measured by bioelectrical impedance analysis using the InBody H30 body composition analyzer and reported as a percentage (%). Change from baseline to follow-up will be evaluated.
Time frame: Baseline and approximately 3 months after baseline
Change in Skeletal Muscle Mass
Skeletal muscle mass will be measured by bioelectrical impedance analysis using the InBody H30 body composition analyzer and reported in kilograms (kg). Change from baseline to follow-up will be evaluated.
Time frame: Baseline and approximately 3 months after baseline
Change in Exercise Self-Efficacy
Exercise self-efficacy will be assessed using the Exercise Self-Efficacy Scale (ESES), which evaluates participants' confidence in maintaining regular exercise when facing barriers such as fatigue, lack of time, or unfavorable weather. Higher scores indicate greater exercise self-efficacy. Change from baseline to follow-up will be evaluated.
Time frame: Baseline and approximately 3 months after baseline
Change in Health-Related Quality of Life
Health-related quality of life will be assessed using the Chinese version of the Pediatric Quality of Life Inventory Generic Core Scales. The scale contains 23 items covering physical, emotional, social, and school functioning. Scores are transformed to a 0-100 scale, with higher scores indicating better health-related quality of life. Change in the total score from baseline to follow-up will be evaluated.
Time frame: Baseline and approximately 3 months after baseline
Change in Fasting Blood Glucose
Fasting blood glucose will be assessed by laboratory testing after an overnight fast. Change will be calculated as the follow-up value minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Fasting Insulin
Fasting insulin will be assessed by laboratory testing after an overnight fast. Change will be calculated as the follow-up value minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)
Insulin resistance will be estimated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), calculated from fasting glucose and fasting insulin concentrations. Higher values indicate greater insulin resistance. Change will be calculated as the follow-up value minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Glycated Hemoglobin (HbA1c)
Glycated hemoglobin (HbA1c) will be assessed by laboratory testing and reported as a percentage (%). Change will be calculated as the follow-up value minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Total Cholesterol Concentration
When available, total cholesterol concentration will be recorded from routine clinical laboratory testing performed during clinical re-examination and reported in millimoles per liter (mmol/L). Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Triglyceride Concentration
Triglyceride concentration will be recorded from routine clinical laboratory testing conducted as part of routine clinical re-examination and reported in millimoles per liter (mmol/L). No additional blood sample will be collected solely for this study. Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Low-Density Lipoprotein Cholesterol (LDL-C) Concentration
Low-density lipoprotein cholesterol (LDL-C) concentration will be recorded from routine clinical laboratory testing conducted as part of routine clinical re-examination and reported in millimoles per liter (mmol/L). No additional blood sample will be collected solely for this study. Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in High-Density Lipoprotein Cholesterol (HDL-C) Concentration
High-density lipoprotein cholesterol (HDL-C) concentration will be recorded from routine clinical laboratory testing conducted as part of routine clinical re-examination and reported in millimoles per liter (mmol/L). No additional blood sample will be collected solely for this study. Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Alanine Aminotransferase (ALT) Activity
Alanine aminotransferase (ALT) activity will be recorded from routine clinical laboratory testing conducted as part of routine clinical re-examination and reported in units per liter (U/L). No additional blood sample will be collected solely for this study. Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Aspartate Aminotransferase (AST) Activity
Aspartate aminotransferase (AST) activity will be recorded from routine clinical laboratory testing conducted as part of routine clinical re-examination and reported in units per liter (U/L). No additional blood sample will be collected solely for this study. Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
Change in Serum Uric Acid Concentration
Serum uric acid concentration will be recorded from routine clinical laboratory testing conducted as part of routine clinical re-examination and reported in micromoles per liter (μmol/L). No additional blood sample will be collected solely for this study. Change from baseline will be calculated as the value at approximately 3 months after baseline minus the baseline value.
Time frame: Baseline and approximately 3 months after baseline
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Nanjing Children's Hospital