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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Willeboordse M, Jansen MW, van den Heijkant SN, Simons A, Winkens B, de Groot R, Bartelink N, Kremers SP, van Assema P, Savelberg HH, de Neubourg E, Borghans L, Schils T, Coppens KM, Dietvorst R, ten Hoopen R, Coomans F, Klosse S, Conjaerts M, Oosterhoff M, Joore MA, Ferreira I, Muris P, Bosma H, Toppenberg HL, van Schayck CP. The Healthy Primary School of the Future: study protocol of a quasi-experimental study. BMC Public Health 2016; 16:639. [PMID: 27456845 PMCID: PMC4960894 DOI: 10.1186/s12889-016-3301-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined. METHODS In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019. DISCUSSION A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society. TRIAL REGISTRATION The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 .
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Affiliation(s)
- M. Willeboordse
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M. W. Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S. N. van den Heijkant
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - A. Simons
- MOVARE Educational board, Kerkrade, The Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - R.H.M. de Groot
- Welten Institute - Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - N. Bartelink
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands
- Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S. P. Kremers
- Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - P. van Assema
- Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - H. H. Savelberg
- Department of Human Movement Sciences, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - E. de Neubourg
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - L. Borghans
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - T. Schils
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - K. M. Coppens
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - R. Dietvorst
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - R. ten Hoopen
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - F. Coomans
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - S. Klosse
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - M.H.J. Conjaerts
- Academic Hospital Maastricht, Treatment and Care Unit, Maastricht, The Netherlands
| | - M. Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - M. A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - I. Ferreira
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
- School of Public Health, The University of Queensland, Herston, Brisbane Australia
| | - P. Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - H. Bosma
- Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - H. L. Toppenberg
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Mei H, Xiong Y, Xie S, Guo S, Li Y, Guo B, Zhang J. The impact of long-term school-based physical activity interventions on body mass index of primary school children - a meta-analysis of randomized controlled trials. BMC Public Health 2016; 16:205. [PMID: 26931236 PMCID: PMC4774105 DOI: 10.1186/s12889-016-2829-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/04/2016] [Indexed: 12/22/2022] Open
Abstract
Background Physical activity (PA) intervention is a commonly recommended strategy to combat childhood obesity. However, its effectiveness has long been controversial. This paper aims to examine the effectiveness of long-term (≥12 months) school-based PA interventions on body mass index (BMI) in primary school children, who are gaining BMI. Methods Original papers were retrieved from PubMed, Google Scholar, the Cochrane Library and Web of Science, published between 1990 and 2015. The inclusion criteria were those research studies that were: randomized controlled trials (RCTs), conducted in primary school settings, had valid data on BMI at baseline and at the final follow up (or on BMI changes), and involved PA intervention that lasted for at least 12 months. Results Out of 11,158 potentially eligible articles, 18 papers were included in the analysis, involving 22,381 primary school children with intervention durations ranging from 12 to 72 months. Compared to the control groups, the BMI increment was 2.23 kg/m2 less in the intervention groups (p < 0.05). The heterogeneity was high across the studies (99.8 %), but declined after sub-group analyses. The intervention type, intervention duration, and weekly PA intervention time were among the factors leading to the heterogeneity. Conclusion Long-term school-based interventions containing PA as a core component appear to be effective in achieving healthier BMI. However, the results should be interpreted with caution due to the high heterogeneity among the studies. More high quality school-based RCTs among diverse populations are needed to improve the homogeneity and to yield a more robust conclusion.
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Affiliation(s)
- Hong Mei
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Yuelin Xiong
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Shuixian Xie
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Siyu Guo
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Yukun Li
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Bingbing Guo
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Jianduan Zhang
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
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