{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:48:46Z","timestamp":1788191326207,"version":"build-2803163510"},"reference-count":77,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate the effect of a stress management protocol with diaphragmatic breathing (DB) and physiotherapy exercise on stress, body composition, cardiorespiratory and metabolic markers of children and adolescents with morbid obesity. Methods: The study included 31 children and adolescents (5\u201318 years old) with morbid obesity (22 in the intervention arm and 9 controls). All participants completed anxiety questionnaires and a self-perception scale. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), blood pressure (BP) and SpO2 were measured. Fasting glucose, uric acid, triglycerides, HbA1c, (AST\/SGOT), (ALT\/SGPT), HDL, LDL, insulin, ACTH, cortisol, HOMA-IR, 17-OH, S-DHEA, SHBG were assessed, and anthropometric measurements were also performed. Results: In the intervention group, 4 months after the treatment, an improvement was noted in the BMI, BMI z-score, waist-to-height ratio, FEV1, SpO2, pulse and systolic BP. HDL increased, ALT\/SGPT and insulin resistance improved. Positive changes were observed in temporary and permanent stress and self-esteem of children in the intervention group, including anxiety, self-perception, physical appearance, etc. Conclusions: A combined exercise and DB protocol has a positive effect on stress, by improving body composition, reducing insulin resistance, and ameliorating physical and mental health and quality of life of pediatric patients with morbid obesity.<\/jats:p>","DOI":"10.3390\/children12081010","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:37:47Z","timestamp":1754030267000},"page":"1010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of a Physiotherapy Stress-Management Protocol on Cardiorespiratory, Metabolic and Psychological Indicators of Children and Adolescents with Morbid Obesity"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1585-7053","authenticated-orcid":false,"given":"Pelagia","family":"Tsakona","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, International Hellenic University, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hristara-Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, International Hellenic University, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Apostolou","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, International Hellenic University, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ourania","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, International Hellenic University, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-5487","authenticated-orcid":false,"given":"Ioannis","family":"Kitsatis","sequence":"additional","affiliation":[{"name":"Medical School, Aristotle University of Thessaloniki, University Campus, 54624 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3453-3986","authenticated-orcid":false,"given":"Eleni G.","family":"Paschalidou","sequence":"additional","affiliation":[{"name":"Endocrine Unit, 3rd Department of Pediatrics, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2842-2320","authenticated-orcid":false,"given":"Christos","family":"Tzimos","sequence":"additional","affiliation":[{"name":"Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str., 54646 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4167-6595","authenticated-orcid":false,"given":"Maria G.","family":"Grammatikopoulou","sequence":"additional","affiliation":[{"name":"Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7449-5083","authenticated-orcid":false,"given":"Kyriaki","family":"Tsiroukidou","sequence":"additional","affiliation":[{"name":"Endocrine Unit, 3rd Department of Pediatrics, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1016\/S0140-6736(14)61746-3","article-title":"Child and Adolescent Obesity: Part of a Bigger Picture","volume":"385","author":"Lobstein","year":"2015","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Braun, J.M., Kalkwarf, H.J., Papandonatos, G.D., Chen, A., and Lanphear, B.P. 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