Effects of school-based interventions for direct delivery of physical activity on fitness and cardiometabolic markers in children and adolescents: a systematic review of randomized controlled trials

The effectiveness of physical activity interventions on blood pressure in children and adolescents: A systematic review and network meta-analysis

BACKGROUND

High blood pressure (BP) is a major contributor to mortality and cardiovascular diseases. Despite the known benefits of exercise for reducing BP, it is crucial to identify the most effective physical activity (PA) intervention. This systematic review and network meta-analysis (NMA) aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP.

METHODS

A search of PubMed, SPORTDiscus, PsycINFO, Web of Science, CINAHL, Cochrane, and Eric databases was conducted up to December 2022 for this systematic review and NMA. Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6-12 years old were included in this study. Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent investigators performed the literature screening, data extraction, and risk of bias assessment. We used Bayesian arm-based NMA to synthesize the data. The primary outcomes were systolic BP and diastolic BP. We calculated the mean differences (MDs) in systolic BP and diastolic BP before and after treatment. Mean treatment differences were estimated using NMA and random-effect models.

RESULTS

We synthesized 27 studies involving 15,220 children and adolescents. PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP ((MD = -8.64, 95% credible interval (95%CI):-11.44 to -5.84); (MD = -6.75, 95%CI: -10.44 to -3.11)), followed by interventions with multiple components ((MD = -1.39, 95%CI: -1.94 to -0.84); (MD = -2.54, 95%CI: -4.89 to -0.29)).

CONCLUSION

Our findings suggest that PA interventions incorporating nutrition and behavior change, followed by interventions with multiple components, are most effective for reducing both systolic BP and diastolic BP in children and adolescents.

Physical Activity, Body Composition, Physical Fitness, and Body Dissatisfaction in Physical Education of Extremadura Adolescents: An Exploratory Study

In recent years, physical activity levels among youths have declined significantly. This has led to a decline in adherence to physical activity recommendations. In this sense, physical education offers an ideal environment that contributes positively to improving adherence to physical activity recommendations, as it teaches students movement-related skills and knowledge. The objective of the present research was to investigate the relationship between physical activity levels, body composition, fitness in Physical Education, and body dissatisfaction levels, and to analyse sex differences in relation to the study variables. The sample was formed of 1166 participants from the 1st and 2nd secondary compulsory education, of which 642 were boys (age 13.16 ± 0.91), and 524 girls (age 13.08 ± 0.85). The measure of physical activity was the Physical Activity Questionnaire for Adolescents (PAQ-A). Body composition was assessed using weight and height to calculate their body mass index. Cardiorespiratory capacity was assessed using the Course-Navette test in Physical Education lessons. The results showed the relationship between physical activity and body mass index, cardiorespiratory capacity, and body satisfaction. It was also confirmed that higher levels of physical activity were associated with a lower body mass index, improvements in cardiorespiratory fitness, and lower levels of body dissatisfaction to a greater extent in boys than in girls. The study concludes that improvements in the study variables were associated with increased physical activity. In addition, it seems necessary to promote healthy lifestyles in physical education lessons, especially during adolescence, as they could serve as a gateway for the improvement of health-related fitness in future generations. Increasing the amount of physical activity among young people is vital. Therefore, it would be essential to develop intervention programs in physical education classes, especially during adolescence, aimed at promoting and increasing physical activity and its benefits.

Effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness: A multi-country cluster randomized controlled trial

PURPOSE

To examine the effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness in children aged 7-8 years.

METHODS

Twenty schools in 5 different European countries (2 second-grade classrooms per school) participated in a cluster randomized controlled trial (Sport at School trial). Participants were assigned to either a control group, which continued with their habitual physical education lessons, or to an intervention group, which replaced these lessons with a 1-year karate intervention (Karate Mind and Movement program). A total of 721 children (344 girls and 377 boys, 7.4 ± 0.5 years old, mean ± SD) completed the study, of which 333 and 388 were assigned to the control group and intervention group, respectively. Outcomes included academic performance (average grade), psychosocial functioning (Strengths and Difficulties Questionnaire for parents), and different markers of physical fitness (cardiorespiratory fitness, balance, and flexibility).

RESULTS

The intervention provided small but significant benefits compared to the control group for academic achievement (d = 0.16; p = 0.003), conduct problems (d = -0.28; p = 0.003), cardiorespiratory fitness (d = 0.36; p < 0.001), and balance (d = 0.24; p = 0.015). There was a trend towards significant benefits for flexibility (d = 0.24; p = 0.056). No significant benefits were observed for other variables, including psychosocial difficulties, emotional symptoms, hyperactivity/inattention, peer problems, or prosocial behaviour (all p > 0.05).

CONCLUSION

A 1-year school-based karate intervention was effective in improving academic achievement, conduct problems, and physical fitness in primary school children. The results support the inclusion of karate during physical education lessons.

Tracking of Cardiorespiratory Fitness from Childhood to Mid-adulthood

High cardiorespiratory fitness (CRF) in adulthood is important for survival from major chronic diseases and preserving good health. We examined how childhood CRF tracks, or persists, into adulthood. Among a cohort of 748 school children followed over 34 years, we found child CRF correlated with young- (r = 0.30) and mid-adulthood (r = 0.16) CRF.

Youth Sport Participation by Metropolitan Status: 2018-2019 National Survey of Children's Health (NSCH)

Purpose: This cross-sectional study used data from the 2018-2019 National Survey of Children's Health to examine the association between metropolitan statistical area (MSA) status and sports participation among American youth ages 6-17. Methods: Weighted prevalence statistics were computed for sports participation by MSA status (non-MSA, MSA), overall and by child sex and age. Modified Poisson regression was used to estimate prevalence ratios (PR) for non-MSA versus MSA youth, before and after adjusting for special health-care needs, race/ethnicity, household income, parent education, and family structure. Results: The final sample included 30,029 youth [Mage = 11.6 years (SD = 0.4), 51.4% female, 49.0% White]. About 56% participated in sports in the past year. Sports participation was significantly higher among females versus males [59.1% (95% CI: 57.4%-60.7%) versus 52.1% (95% CI: 50.4%-53.8%), p < .001]. Among ages 6-11, those in non-MSAs (versus MSAs) were less likely to participate in sports [PR 0.92 (95% CI: 0.86-0.99), p = .033], which was non-significant after adjustment. In adjusted models, youth ages 12-17 in non-MSAs (versus in MSAs) were more likely to participate in sports overall [aPR 1.07 (95% CI: 1.00-1.15), p = .042] and among males [aPR 1.12 (95% CI: 1.01-1.23), p = .026]. Conclusion: The relationship between MSA status and sports participation may be largely driven by factors that affect youth's ability to participate in sports. Sports participation was higher among females versus males overall. In the models adjusted for demographics, non-MSA youth ages 12-17 were more likely to participate, particularly males. Efforts promoting youth sports should consider differences in socio-demographic factors between MSA versus non-MSA areas to help increase participation.

A cohort study of factors influencing the physical fitness of preschool children: a decision tree analysis

Objective

Based on the decision tree model, to explore the key influencing factors of children's physical fitness, rank the key influencing factors, and explain the complex interaction between the influencing factors.

Methods

A cohort study design was adopted. 1,276 children (ages 3-6) from 23 kindergartens in Nanchang, China, were chosen for the study to measure the children's physical fitness at baseline and a year later and to compare the physical fitness scores at the two stages. The study was conducted following the Chinese National Physical Fitness Testing Standard (Children Part); To identify the primary influencing factors of changes in physical fitness, a decision tree model was developed, and a questionnaire survey on birth information, feeding patterns, SB, PA, dietary nutrition, sleep, parental factors, and other relevant information was conducted.

Results

The levels of physical fitness indicators among preschool children showed a significant increase after 1 year. The accuracy of the CHAID model is 84.17%. It showed that 7 variables were strongly correlated with the physical changes of children's fitness, the order of importance of each variable was weekend PA, weekend MVPA, mother's BMI, mother's sports frequency, father's education, mother's education, and school day PA. Three factors are related to PA. Four factors are related to parental circumstances. In addition to the seven important variables mentioned, variables such as breakfast frequency on school day, puffed food, frequency of outing, school day MVPA, parental feeling of sports, father's occupation, and weekend breakfast frequency are all statistically significant leaf node variables.

Conclusion

PA, especially weekend PA, is the most critical factor in children's physical fitness improvement and the weekend MVPA should be increased to more than 30 min/d based on the improvement of weekend PA. In addition, parental factors and school day PA are also important in making decisions about changes in fitness for children. The mother's efforts to maintain a healthy BMI and engage in regular physical activity are crucial for enhancing the physical fitness of children. Additionally, other parental factors, such as the parents' educational levels and the father's occupation, can indirectly impact the level of physical fitness in children.

A cluster randomized trial of a comprehensive intervention nesting family and clinic into school centered implementation to reduce myopia and obesity among children and adolescents in Beijing, China: study protocol

BACKGROUND

Myopia and obesity in children and adolescents have become serious public health problems that endanger public health, especially in China. Unhealthy lifestyle behaviors are environmental drivers of both myopia and obesity. This protocol describes a study to evaluate the effectiveness of "22510SS", that is 2 h of daytime outdoor activities ('2'); Limit screen time to no more than 2 h per day ('2'); Consume at least 5 servings of fruits and vegetables daily ('5'); Attain 1 h of physical activity daily ('1'); Consume 0 sugar-sweetened beverages ('0'); Reasonable sleep duration ('S'); Regular supervision ('S'). A school-based, multifaceted intervention strategy for myopia and obesity prevention, and to assess and explore the implementation of "22510SS" with regards to acceptability, feasibility, adoption, usage and maintenance.

METHODS AND ANALYSIS

This study aims to develop a comprehensive intervention strategy "22510SS" based on the socio-ecological model, and A two-arm cluster randomized trial with a parallel-group of a 1:1 allocation ratio in 36 primary and secondary schools to test its evidence-based intervention programs on the effects and implementation of myopia and obesity epidemics in children and adolescents in grades 4 and 7. The primary outcomes will include differences in visual acuity, body mass index, outdoor activity indicators, screen time, fruit and vegetable intake, high-quality protein intake, sugar-sweetened beverage intake, sleep duration, and level of monitoring among children and adolescents. Secondary outcomes will assess the acceptability, feasibility, uptake, use, and maintenance of the intervention. Effects on the primary and secondary outcomes will be analyzed using linear and logistic regression analyses, as well as difference-in-difference analysis, taking into account cluster effects and possible confounding factors. Process assessments will also be conducted through quantitative and qualitative analyses, including acceptability, feasibility, gender, adoption, implementation, and sustainability.

DISCUSSION

This study will evaluate the effectiveness of "22510SS" and examine its implementation in the school-based network nesting family and clinic. Following this intervention study, the integrated intervention program focused on myopia and obesity among children and adolescents have great potential to be implemented in China to promote and support healthy lifestyle behavior change and reduce the risk of myopia and obesity in children and adolescents.

TRIAL REGISTRATION

NCT05275959. Registered 23 Mach 2022.

Effects of school-based physical activity interventions on physical fitness and cardiometabolic health in children and adolescents with disabilities: a systematic review

Background: This study aimed to examine the influence of school-based physical exercise programs on physical fitness and cardiometabolic health in children and adolescents with disabilities. Methods: Web of Science, Scopus, and PubMed were thoroughly searched to identify relevant investigations. To be included in the systematic review, studies needed to fulfill the following inclusion criteria: 1) performed school-based physical exercise interventions; 2) parameters evaluated referred to health-related physical fitness (HRPF), skill-related physical fitness (SRPF), and cardiometabolic health; 3) a sample of participants consisted of children and adolescents with disabilities; 4) the mean age of respondents was less than 18 years; and 5) were written in the English language. Results: After searching the databases, a total of 474 studies have been identified, 18 of them met the eligibility criteria, and their outcomes were presented. Relating to the respondents' characteristics, the investigations involved 681 children and adolescents with disabilities, out of which 440 were male and 241 female. Regarding types of physical exercise interventions, the most commonly implemented were combined aerobic and resistance training, aerobic exercise, sports games, adapted high-intensity interval training, as well as sprint interval training. The obtained results unambiguously demonstrated that applied exercise interventions improved HRPF components such as cardiorespiratory fitness, muscular fitness, and flexibility. In terms of the SRPF, agility, balance, coordination, and power were considerably enhanced following the school-based exercise. On the other hand, the influence on indices of body composition and cardiometabolic health is quite controversial. The majority of the available studies did not find favorable effects. Additionally, no adverse events were reported in 7 of 8 research, and adherence to exercise was approximately 92%. Conclusion: School-based physical exercise programs were very efficient in improving HRPF and SRPF in children and adolescents with disabilities, while the evidence concerning the variables of body composition and cardiometabolic health is inconclusive and warrants further investigations.

Comparative effectiveness of school-based exercise interventions on physical fitness in children and adolescents: a systematic review and network meta-analysis

Background

Schools provide a favorable setting for health education, however, the most effective school-based exercise mode for improving physical fitness remains unclear. This network meta-analysis was designed to assess and rank the comparative efficacy of six exercise modalities on physical fitness indicators in a school-based setting.

Methods

An online search of the Web of Science, PubMed, SPORTDiscus, and Scopus databases was conducted. Randomized and quasi-randomized controlled trials were considered. Outcomes included measures of anthropometry and body composition, muscular fitness, and cardiorespiratory fitness. Data were pooled with a random effects model using the frequentist framework.

Results

A total of 66 studies with 8,578 participants (48% girls) were included. High-intensity interval training was the most effective intervention reducing body mass index (mean difference (MD) = -0.60 kg·m^-2, 95% confidence interval (95%CI) = -1.04 to -0.15, p = 0.009), elevating VO_2max (MD = 3.59 mL·kg^-1·min^-1, 95% CI = 2.45 to 4.74, p < 0.001), and 20-meter sprint performance (MD = -0.35 s, 95% CI = -0.55 to -0.14, p = 0.001). Aerobic training had the highest probability of reducing waist circumference (standardized mean difference (SMD) = -0.60, 95% CI = -0.88 to -0.32, p < 0.001). Active video games emerged as a promising modality for improving countermovement jump (MD = 2.43 cm, 95% CI = 0.06 to 4.80, p = 0.041) and shuttle running performance (SMD = 0.86, 95% CI = 0.29 to 1.43, p = 0.003). Strength training was the best exercise mode for improving standing long jump performance (SMD = 1.03, 95% CI = 0.07 to 1.98, p = 0.035) while combined training was rated the first for decreasing body fat percent (MD = -2.56%, 95% CI = -4.73 to -0.40, p = 0.022) and increasing push-up repetitions (SMD = 3.59, 95% CI = 0.81 to 6.37, p = 0.012).

Conclusion

School-based exercise interventions have multiple effects on physical fitness. The findings of this study will help to inform physical education teachers and coaches how best to deliver exercise programs in a school setting. Since the study was limited by the original research, the conclusions will require further verification using high-quality randomized controlled trials.

Systematic Review Registration

PROSPERO, Identifier: CRD42023401963.

Study on the Influence of Regular Physical Activity on Children's Oral Health

The benefits of physical activities conducted systematically on the harmonious development, intellectual performance, and general health of children are unanimously accepted. This study's aim is to determine whether differences in oral health between young athletes and children not engaged in competitive sports are present. A total of 173 children aged between 6 and 17 years, 58 hockey players, 55 football players, and 60 in the control group were divided into groups according to their activity, age, and biological sex and examined for oral hygiene and dental and periodontal health, using clinically determined indices. Statistical analysis showed significant differences between the groups, with lower (better) values for athletes, regardless of age, sex, or activity. Oral hygiene showed the most relevant differences for males aged 14 to 17, as did the index for dental health. Periodontal health, on the other hand, was significantly better for females aged 6 to 13. Based on this data, the beneficial influence of regular physical activity also has an impact on oral health. Identifying the mechanisms behind this needs to be explored in depth and may be a topic for further research.

Effectiveness of an adapted physical activity intervention on health-related physical fitness in adolescents with intellectual disability: a randomized controlled trial

This study aimed to examine the effects of an adapted physical activity (APA) intervention on health-related physical fitness (HRPF) in adolescents with intellectual disability (ID). With a randomized controlled trial design, adolescents aged 12-18 years, with mild and moderate ID, and being overweight and obese were recruited and randomly assigned to either an intervention or a control group. The APA intervention consisted of overall moderate intensity aerobic and resistance exercise, with a duration of 45 min/session, a frequency of 2 sessions/week, and lasting for 9 months. A negative control was involved, in which participants received no treatment. Changes in four fitness tests, including the 9-min run/walk, handgrip strength, 30-s sit-ups, and sit-and-reach tests, were assessed between the groups using general linear models. A total of 57 participants (39 in the intervention group and 18 in the control group) completed the study. Significant mean differences in changes in the 9-min run/walk test (413.6 m [95% CI 146.72 m, 680.41 m], p = 0.003) and the right-side sit-and-reach test (2.2 cm [95% CI 0.37 cm, 4.09 cm], p = 0.020) respectively were observed in the intervention group, compared to the control group. No significant between-group improvement was observed for the handgrip strength and the 30-s sit-ups tests. The APA intervention induced beneficial effects on cardiorespiratory fitness and potential beneficial effects on flexibility for adolescents with ID. However, no significant effects of this intervention on muscular strength and endurance were observed in this study. Future studies should consider involving effective exercises in interventions to improve muscular strength and endurance.

Prevention of atherosclerosis from childhood

Cardiovascular diseases caused by atherosclerosis do not typically manifest before middle age; however, the disease process begins early in life. Preclinical atherosclerosis can be quantified with imaging methods in healthy populations long before clinical manifestations present. Cohort studies have shown that childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure and tobacco smoking, are associated with adult preclinical atherosclerotic phenotypes. Importantly, these long-term effects are substantially reduced if the individual becomes free from the risk factor by adulthood. As participants in the cohorts continue to age and clinical end points accrue, the strongest evidence linking exposure to risk factors in early life with cardiovascular outcomes has begun to emerge. Although science has deciphered the natural course of atherosclerosis, discovered its causal risk factors and developed effective means to intervene, we are still faced with an ongoing global pandemic of atherosclerotic diseases. In general, atherosclerosis goes undetected for too long, and preventive measures, if initiated at all, are inadequate and/or come too late. In this Review, we give an overview of the available literature suggesting the importance of initiating the prevention of atherosclerosis in early life and provide a summary of the major paediatric programmes for the prevention of atherosclerotic disease. We also highlight the limitations of current knowledge and indicate areas for future research.

Effects of school-based before-school physical activity programmes on children's physical activity levels, health and learning-related outcomes: a systematic review

OBJECTIVE

To review and evaluate the impact of school-based, before-school physical activity (PA) programmes on children's PA levels, health and learning-related outcomes.

DESIGN

Systematic review.

DATA SOURCES

PubMed, PsycINFO, Scopus, Embase and ERIC were searched in January 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: (1) Original research published in English, (2) sample included typically developing school-age children and/or adolescents, (3) examined school-based PA programmes delivered before school, (4) included a comparator and (5) reported associations with PA, physical health, learning-related and/or psychosocial outcomes. Studies examining before-school active transport or sport were excluded.

RESULTS

Thirteen articles representing 10 studies were included (published 2012-2020); seven conducted in primary schools. Programmes ranged between 3 weeks and 6 months, primarily operating daily and for 25-40 min. One study examined a programme informed by theory; six incorporated fidelity measures. Data synthesis, considering consistency of findings, showed indeterminate associations for the domains of physical health, learning-related and psychosocial outcomes. Among subdomains, synthesis showed positive associations with before-school and daily PA, cardiorespiratory and muscular fitness, readiness to learn and an inverse association with adiposity. Risk of bias was high/serious or insufficiently detailed across studies and outcome domains, except PA, which included moderate-risk studies.

CONCLUSION

There is limited available evidence on school-based, before-school PA programmes, with some positive associations at domain and subdomain levels. Continued research is justified to understand the role of before-school programmes for facilitating PA. Future research should follow recommended practice for intervention design and process evaluation, and address under-represented contexts, including secondary schools.

PROSPERO REGISTRATION NUMBER

CRD42020181108.

Needs assessment for physical activity information during COVID-19 among a nationally representative sample of parents and children ages 6-17 in the United States: a cross-sectional study

Background

The COVID-19 pandemic presented novel barriers to youth physical activity engagement. Identifying what resources parents and children are interested in receiving can support efforts to mitigate the negative impact of the pandemic on youth physical activity behavior. This study aimed to identify physical activity-related information needs during the COVID-19 pandemic among a nationally representative sample of American parents of children 6–10 years-old and parent-child dyads of children 11–17 years-old.

Methods

A cross-sectional survey was conducted by a market research company in October–November 2020. Parents and children were asked about their interest in specific types of information about helping their family and themselves, respectively, be active (Yes/No). Weighted percentages were calculated for reported information needs and compared using two-sample test of proportions.

Results

Final analytic sample was 1000 parents (55.4% female; 74.7% White; 74.0% non-Hispanic); 500 children 11–17 years-old (52.1% male; 77.6% White). Over 40% of participants were interested in information about being active during COVID-19. Parents were more likely to be interested in information if they always (versus never) worked from home [53.3% (95% CI: 43.3–63.0%) versus 22.0% (95% CI: 14.9–31.3%), p < 0.001]; had children attending school remotely versus in-person [47.3% (95% CI:40.2–54.5%) versus 27.5% (95% CI: 19.6–37.1%), p < 0.001]; and lived in a big city versus a rural area [66.5% (95% CI:54.5–76.7%) versus 34.1% (95% CI: 22.8–47.6%), p < 0.001]. Children most interested were those who did not have resources for online activity engagement and those worried about their safety or getting infected with COVID-19. Children were also more likely to be interested if their parents worked full-time versus not working [48.6% (95% CI:41.7–55.6%) versus 31.5% (95% CI: 24.1–39.9%), p < 0.001], and lived in a big city versus a rural area [57.2% (95% CI:45.3–68.3%) versus 27.8% (95% CI:17.8–40.7%), p < 0.001].

Conclusions

Families are interested in physical activity resources, particularly those whose daily routines and opportunities for physical activity may have been most significantly impacted by the pandemic. This includes parents who always worked from home or whose children attended school remotely. Identifying felt needs is an important step in developing tailored interventions that aim to effectively and sustainably support families in promoting physical activity.

High-Intensity Interval Training and Cardiometabolic Risk Factors in Children: A Meta-analysis

CONTEXT

High-intensity interval training (HIIT) has been widely used to prevent and treat cardiovascular risk factors in adolescents and adults; nevertheless, the available evidence in children is scarce.

OBJECTIVE

To synthesize evidence regarding the effectiveness of HIIT interventions on improving cardiovascular risk factors and cardiorespiratory fitness (CRF) in children from 5 to 12 years old.

DATA SOURCES

We searched 5 databases, Medline, Embase, SPORTDiscus, the Cochrane Library, and Web of Science.

STUDY SELECTION

Randomized controlled trials (RCTs) evaluating the effectiveness of HIIT interventions on cardiometabolic risk factors and CRF in children were included.

DATA EXTRACTION

Meta-analyses were conducted to determine the effect of HIIT on body composition, cardiometabolic and CRF variables in comparison with nontraining control groups.

RESULTS

A total of 11 RCTs and 512 participants were included. The results of the meta-analysis revealed a significant improvement in peak oxygen uptake (standardized mean difference [SMD] = 0.70, 95% confidence interval [CI] = 0.28 to 1.12; P = 0.001], in total cholesterol [SMD = -1.09, 95% CI = -1.88 to -0.30; P = 0.007], in low-density lipoprotein cholesterol [SMD = -1.28, 95% CI = -2.34 to -0.23; P = 0.017] and triglycerides [SMD = -0.71, 95% CI = -1.15 to -0.28; P = 0.001) levels.

LIMITATIONS

Because of the small number of available RCTs, it was not possible to conduct a subgroup analysis or a linear meta-regression analysis.

CONCLUSIONS

HIIT is a feasible and time-efficient approach for improving CRF, total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels in children.

Effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness: A multi-country cluster randomized controlled trial

PURPOSE

To examine the effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness in children aged 7-8 years.

METHODS

Twenty schools in 5 different European countries (2 second-grade classrooms per school) participated in a cluster randomized controlled trial (Sport at School trial). Participants were assigned to either a control group, which continued with their habitual physical education lessons, or to an intervention group, which replaced these lessons with a 1-year karate intervention (Karate Mind and Movement program). A total of 721 children (344 girls and 377 boys, 7.4 ± 0.5 years old, mean ± standard deviation) completed the study, of which 333 and 388 were assigned to the control group and intervention group, respectively. Outcomes included academic performance (average grade), psychosocial functioning (Strengths and Difficulties Questionnaire for parents), and different markers of physical fitness (cardiorespiratory fitness, balance, and flexibility).

RESULTS

The intervention provided small but significant benefits compared to the control group for academic achievement (d = 0.16; p = 0.003), conduct problems (d = -0.28; p = 0.003), cardiorespiratory fitness (d = 0.36; p < 0.001), and balance (d = 0.24; p = 0.015). There was a trend towards significant benefits for flexibility (d = 0.24; p = 0.056). No significant benefits were observed for other variables, including psychosocial difficulties, emotional symptoms, hyperactivity/inattention, peer problems, or prosocial behavior (all p > 0.05).

CONCLUSION

A 1-year school-based karate intervention was effective in improving academic achievement, conduct problems, and physical fitness in primary school children. The results support the inclusion of karate during physical education lessons.

Physiotherapy and related management for childhood obesity: A systematic scoping review

INTRODUCTION

Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

METHOD

A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

RESULTS

From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

CONCLUSION

When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

Activity patterns of primary school children during participation in The Daily Mile

The Daily Mile is a popular physical activity initiative in primary schools, yet little is known regarding the activity patterns of children during The Daily Mile. Eighty children (10.4 ± 0.7 years) participated in The Daily Mile (20-min). Activity patterns were assessed using global positioning systems (total distance and age-specific speed zones), alongside heart rate. Cardiorespiratory fitness was assessed using the Multi-Stage Fitness Test. Participants covered a distance of 2511 ± 550 m during The Daily Mile, and heart rate was 163 ± 27 beats^.min^-1. Participants travelled the furthest distance, and were most intermittent, during the first 5 min (main effect of time, both p < 0.001). Boys ran further and their activity was more intermittent compared to girls (main effect of sex, both p < 0.001). Moreover, the highest fit children ran further than less fit children (main effect of fitness, p < 0.001). This study provides novel evidence of the nature of physical activity during The Daily Mile; demonstrating that children covered, on average, 1.5-miles and exercised at a moderate-to-vigorous intensity. Furthermore, boys covered a greater distance and were more intermittent than girls; whilst higher fit children ran further than lower fit children. In summary, The Daily Mile makes a valuable contribution to in-school physical activity targets in all children.

Tracking of cardiometabolic risk in a Brazilian schoolchildren cohort: a 3-year longitudinal study

BACKGROUND

Clustering of cardiometabolic risk factors is a sign of detrimental health. Tracking is a term used to describe a variable longitudinal stability across time. High tracking provides the chance to determine which cardiometabolic risk factors should be the target of early treatment and prevention efforts. The present study aims to analyze the tracking of cardiometabolic risk factors and clustered cardiometabolic risk score in children across a 3-year time span, and to verify the odds of staying at risk (measured by the clustered score) from baseline to follow-up.

METHODS

Longitudinal study that included 354 (155 boys) children, aged 7-12 years at baseline. A clustered score was calculated by summing the systolic blood pressure, waist circumference, triglycerides, glucose, and the TC/HDL-C ratio Z-scores divided by five. A second clustered score was calculated including cardiorespiratory fitness (CRF).

RESULTS

CRF and anthropometric parameters presented high tracking (r≥0.662), whereas the cardiometabolic parameters exhibited low-to-moderate tracking (0.100≤r≤0.571). The clustered scores' tracking was moderate (r≥0.508; r≥0.588 [CRF]). Participants in the higher risk groups at baseline presented 3.81 (95% CI: 2.40; 6.05) and 4.64 (95% CI: 2.85; 7.56), including CRF, times higher chance of remaining at risk three years later. Moreover, participants in the worst profile regarding CRF or anthropometrics at baseline presented at least 4.00 times higher chance of being at risk three years later.

CONCLUSIONS

Participants with worst CRF and adiposity had an increased risk of presenting higher clustered risk after three years.

Effectiveness of lifestyle interventions in preventing harmful weight gain among adolescents: A systematic review of systematic reviews

Obesity in adolescence is associated with stigma during school years, early emergence of co-morbidities in adulthood and premature mortality. Adolescence presents a key window of opportunity to intervene for building healthy eating and physical activity routines and prevent weight gain. This review of reviews assesses the evidence on the effectiveness of prevention interventions conducted with adolescents. Nine reviews assessing the effects of lifestyle interventions in adolescents (defined as age 10 to 19 years old) on weight gain were identified from the 10 health databases searched. Only four reviews conducted meta-analyses, of which, three (two exercise-focused) demonstrated positive changes in primary outcomes of body mass index (BMI) and/or BMI z-score (range of decrease in BMI from 0.06 to 0.47 kg/m²⁾ ). Most were conducted in school settings, and all but two reviews were of low quality. Few reviews reported external validity components that would enable clearer directions for policy makers to implement in real-world settings. More than 140 distinct interventions were included in the reviews, but there remains a serious gap in evidence for effective interventions in adolescents.

Update on Preventive Cardiology

Although progress had been made in reducing cardiovascular disease (CVD) mortality, the positive trend has reversed in recent years, and CVD remains the most common cause of mortality in US women and men. Youth represent the future of CVD prevention; emerging evidence suggests exposure to risk factors in children contributes to atherosclerosis and results in vascular changes and increased CVD events. The contributors to CVD include those commonly seen in adults. This article reviews hypercholesterolemia, hypertension, obesity, diabetes, and smoking. It discusses the prevalence of each disease, diagnosis, treatment, and cardiovascular complications.

Reducing Aggression and Improving Physical Fitness in Adolescents Through an After-School Volleyball Program

This study aimed to determine the effects of an after-school volleyball program on aggression and physical fitness in 14–16 years old students. One hundred and seven participants were randomized to a small-sided volleyball (SSV) training group or a control group (CON). The SSV group completed 8 months of small-sided volleyball training twice a week after school in addition to the regular physical education classes. Yo-Yo Intermittent Recovery Level 1 test (YYIRT1), medicine ball throw (MED), vertical jump (VJ), and Buss and Perry’s aggression questionnaire were evaluated before and after 8 months of training. Results revealed a significant interaction effect (group × time) in total sample for physical aggression [F(1, 105) = 17.688; p < 0.001], verbal aggression [F(1, 105) = 4.973; p = 0.028], anger [F(1, 105) = 7.662; p = 0.007], medicine ball throw [F(1, 105) = 36.143; p < 0.001], and YYIRT1 [F(1, 105) = 12.508; p = 0.001]. After-school small-sided volleyball for adolescents was accompanied by a significant decrease in aggression compared to physical education classes only. Additionally, adolescents from SSV group showed better results in physical fitness compared to the control group. Our findings significantly contribute to the understanding of possible mechanisms for reducing adolescents’ aggression, which include enjoyment, motivation, and self-control through sport intervention.

Effects of aerobic exercise and cognitively engaging exercise on cardiorespiratory fitness and motor skills in primary school children: A cluster randomized controlled trial

This paper examined effects of two interventions on cardiorespiratory fitness and motor skills, and whether these effects are influenced by baseline levels, and dose of moderate-to-vigorous physical activity (MVPA) during the intervention. A cluster randomized controlled trial was implemented in 22 schools (n = 891; 9.2 ± 07 years). Intervention groups received aerobic or cognitively engaging exercise (14-weeks, four lessons per week). Control groups followed their regular physical education programme. Cardiorespiratory fitness, motor skills and MVPA were assessed. Multilevel analysis showed no main effects on cardiorespiratory fitness and motor skills although the amount of MVPA was higher in the aerobic than in the cognitively engaging and control group. Intervention effects did not depend on baseline cardiorespiratory fitness and motor skills. Children with a higher dose of MVPA within the intervention groups had better cardiorespiratory fitness after both interventions and better motor skills after the cognitively engaging intervention. In conclusion, the interventions were not effective to enhance cardiorespiratory fitness and motor skills at a group level, possibly due to large individual differences and to a total dose of MVPA too low to find effects. However, the amount of MVPA is an important factor that influence the effectiveness of interventions.

The causal pathway effects of a physical activity intervention on adiposity in children: The KISS Study cluster randomized clinical trial

Background

Very little information on the potential mechanisms of the physical activity interventions effects on adiposity is available. We evaluated the possible mediating factors of a physical activity school‐based intervention on the sum of skinfolds in children.

Methods

This is a cluster randomized trial, secondary analysis of the KISS study. Children (n = 499) from the first and fifth grades were randomly assigned to intervention or control group. Adiposity was estimated by four skinfolds, aerobic fitness assessed by the shuttle run test, and insulin, triglycerides, total cholesterol, high‐density lipoprotein (HDL), and glucose collected via fasting blood samples.

Results

The intervention affected aerobic fitness (0.140 SD, 95% CI 0.011 to 0.270), triglycerides (0.217 SD, 95% CI −0.409 to −0.025), cholesterol/HDL ratio (−0.191 SD, 95% CI −0.334 to −0.047), glucose (−0.330 SD, 95% CI −0.538 to −0.121), and skinfolds (−0.122 SD, 95% CI −0.189 to −0.056). No intervention effect on insulin was found. We observed that changes in aerobic fitness impacted children's triglycerides and cholesterol/HDL ratio and consecutively the glucose levels mediating 30% of the intervention effect on skinfolds.

Conclusions

Our findings provided evidence of the positive metabolic distress caused by a physical activity intervention on adiposity levels in children.

Three times as much physical education reduced the risk of children being overweight or obese after 5 years

AIM

We evaluated the effect that increasing physical education lessons from 1.5 to 4.5 hours per week for 5 years had on the body mass index (BMI) and waist circumferences of children aged 5-11 years at inclusion.

METHODS

From 2008 to 2013, six intervention schools in Svendborg, Denmark, delivered 4.5 hours of physical education lessons per week to 750 children. Meanwhile, four matched control schools gave 549 children the standard 1.5 hours of physical education lessons per week. Measurements were taken at baseline and yearly for 5 years. Of the 1299 children, 81 joined the schools after 2008.

RESULTS

At baseline, the percentage of overweight children was 12% in the intervention schools and 13% in the control schools, whereas 15% and 19% were abdominal obese, respectively. After 5 years, the respective risks of remaining abdominal obese or overweight were 43% and 51% in the intervention schools and 78% and 84% in the control schools. Mean BMI increased 0.450 kg/m² more in the control group over the five-year period. The intervention was not effective in decreasing the average waist circumference.

CONCLUSION

Three times as much physical education lessons per week, for 5 years, effectively decreased BMI and the likelihood of remaining overweight or obese.

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.

Effects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial

The onset of cardiometabolic diseases are recognized to occur in childhood. We aimed to investigate the effect of a school-based cluster-randomized controlled trial of physical activity (PA) on single and clustered cardiometabolic risk factors. We included 1129 fifth-grade children from 57 schools (≥seven children in each class) in Sogn and Fjordane County, Norway, randomized to 28 intervention schools and 29 control schools. The PA intervention was conducted between November 2014 and June 2015. Cardiometabolic risk factors were waist circumference (WC), systolic blood pressure (SBP), total cholesterol (TC):high-density lipoprotein (HDL)-ratio, triglycerides (TG), homeostatic model assessment (HOMA)-score, and cardiorespiratory fitness (CRF). PA was measured by accelerometry. No significant intervention effects were found for single or clustered cardiometabolic risk factors. However, in children with the less favorable baseline values, beneficial effects were found for SBP (p = 0.07 for group ∗ tertile interaction), TC:HDL ratio (p = 0.03 for group ∗ tertile interaction) and the clustered cardiometabolic risk score (p = 0.01 for group ∗ tertile interaction). Compared to boys, girls had a greater effect of the intervention on WC (p = 0.03 for group ∗ sex interaction) and CRF (p < 0.001 for group ∗ sex interaction). The majority of the children had high PA levels, thus limited potential for change, and we found no effects of the PA intervention on cardiometabolic risk in the total sample. However, the intervention had a significantly enhanced effect on fatness and fitness of girls compared to boys. Furthermore, the data suggest that children with the least favorable cardiometabolic risk profile and therefore most in need of change can benefit from school-based PA interventions. Trial registration number: Clinicaltrials.gov ID no.: NCT02132494.

Associations of Sedentary Behavior with Physical Fitness and Academic Performance among Chinese Students Aged 8-19 Years

Background: Existing evidence regarding how time spent on various types of sedentary behavior (SB) in relation to physical fitness (PF) and academic performance (AP) in children and adolescents is limited. This cross-sectional study aimed to explore the associations of SB types with PF and AP among 8–19-year-old Chinese students. Methods: A total of 1164 students were recruited from five schools in Zhejiang province, China. Children’s SB was assessed by a valid questionnaire and AP was represented by scores on four courses. PF was measured by Chinese National Student PF Standard battery. The associations were assessed using linear mixed-effects models adjusted for age, school, grade, and class. Results: Students’ screen-based SB was observed to be negatively associated with PF in girls (p < 0.05). Screen-based SB was inversely associated with AP in both girls and boys (p < 0.001). The significant interaction between weekdays and weekends, and SB on AP was observed in girls (p < 0.001). On weekends, screen-based SB ≥ 6 h/day (<3 h/day as reference group) was significantly and negatively associated with AP (p < 0.01 for both sex). Conclusions: Longer screen-based SB, especially on weekends, was related to poorer AP in 8–19-year-old Chinese students. Our findings suggest that restrictions on any type of screen-based SB for leisure on weekends are beneficial to AP in Chinese students.

Methodology of an exercise intervention program using social incentives and gamification for obese children

BACKGROUND

Traditional exercise [supervised exercise (SE)] intervention has been proved to be one of the most effective ways to improve metabolic health. However, most exercise interventions were on a high-cost and small scale, moreover lacking of the long-term effect due to low engagement. On the other hand, it was noteworthy that gamification and social incentives were promising strategies to increase engagement and sustain exercise interventions effects; as well as mobile technologies such as WeChat also can provide an appropriate platform to deploy interventions on a broader, low-cost scale. Thus, we aim to develop a novel exercise intervention ('S&G exercise intervention') that combines SE intervention with gamification and social incentives design through WeChat, with the aim of improving metabolic health and poor behaviors among overweight and obesity children.

METHODS

We propose a randomized controlled trial of a 'S&G exercise intervention' among 420 overweight and obese children who have at least one marker of metabolic syndrome. Children will be randomized to control or intervention group in a 1:1 ratio. The exercise intervention package includes intervention designs based on integrated social incentives and gamification theory, involving targeted essential volume and intensity of activity (skipping rope) as well as monitoring daily information and providing health advice by WeChat. Participants will undertake assessments at baseline, at end of intervention period, in the follow-up time at months 3,6,12. The primary outcome is outcome of metabolic health. Secondary outcomes include behavioral (e.g., diary physical activity, diet) and anthropometric measures (e.g., body fat rate and muscle mass).

DISCUSSIONS

This will be the first study to design an exercise intervention model that combines traditional supervised exercise (SE) intervention with gamification and social incentives theory through WeChat. We believed that this study could explore a low-cost, easy-to-popularize, and effective exercise intervention model for improving metabolic health and promote healthy among obese children. Furthermore, it will also provide important evidence for guidelines to prevent and improve metabolic health and health behaviors.

TRIAL REGISTRATION

10-04-2019;Registration number: ChiCTR1900022396 .

The 20-m Shuttle Run: Assessment and Interpretation of Data in Relation to Youth Aerobic Fitness and Health

Cardiorespiratory fitness (CRF) is a good summative measure of the body's ability to perform continuous, rhythmic, dynamic, large-muscle group physical activity, and exercise. In children, CRF is meaningfully associated with health, independent of physical activity levels, and it is an important determinant of sports and athletic performance. Although gas-analyzed peak oxygen uptake is the criterion physiological measure of children's CRF, it is not practical for population-based testing. Field testing offers a simple, cheap, practical alternative to gas analysis. The 20-m shuttle run test (20mSRT)-a progressive aerobic exercise test involving continuous running between 2 lines 20 m apart in time to audio signals-is probably the most widely used field test of CRF. This review aims to clarify the international utility of the 20mSRT by synthesizing the evidence describing measurement variability, validity, reliability, feasibility, and the interpretation of results, as well as to provide future directions for international surveillance. The authors show that the 20mSRT is an acceptable, feasible, and scalable measure of CRF and functional/exercise capacity, and that it has moderate criterion validity and high to very high reliability. The assessment is pragmatic, easily interpreted, and results are transferable to meaningful and understandable situations. The authors recommend that CRF, assessed by the 20mSRT, be considered as an international population health surveillance measure to provide additional insight into pediatric population health.

School-Based Exercise Programs and Cardiometabolic Risk Factors: A Meta-analysis

CONTEXT

The effects of school-based physical activity (PA) programs on different cardiometabolic risk factors and the most appropriate features of PA programs to achieve maximum effectiveness are unclear.

OBJECTIVE

To provide a comprehensive synthesis of the effectiveness of school-based PA interventions on cardiometabolic risk factors in children.

DATA SOURCES

We identified studies from database inception to February 22, 2018.

STUDY SELECTION

We selected studies that were focused on examining the effect of school-based PA interventions on cardiometabolic risk factors in children.

DATA EXTRACTION

Random-effects models were used to calculate the pooled effect size (ES) for the included cardiometabolic risk factors (waist circumference [WC], triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure and diastolic blood pressure (DBP), and fasting insulin and glucose).

RESULTS

Nineteen randomized controlled trials (which included 11 988 children aged 3-12 years) were included in the meta-analysis. School-based PA programs were associated with a significant small improvement in WC (ES = -0.14; 95% confidence interval [CI]: -0.22 to -0.07; P < .001), DBP (ES = -0.21; 95% CI: -0.42 to -0.01; P = .040), and fasting insulin (ES = -0.12; 95% CI: -0.20 to -0.04; P = .003).

LIMITATIONS

Authors of few studies described the implementation conditions of their interventions in detail, and compliance rates were lacking in most studies. In addition, results by sex were provided in a small number of studies.

CONCLUSIONS

School-based PA interventions improve some cardiometabolic risk factors in children, such as WC, DBP, and fasting insulin.

Predictors of dropout in the school-based multi-component intervention, 'Mexa-se'

To identify the predictors of dropout in the 'Mexa-se' intervention according to the body mass index (BMI) category. This was a controlled, non-randomized study. The intervention included: (i) increase in the intensity of physical activities (PA) in physical education (PE) classes; (ii) active recess; (iii) educational sessions on PA, nutrition and body image; and (iv) educational materials. Dropout was considered when students dropped out of intervention, or did not reach 75% attendance in PE classes. The independent variables were gender, age, study period, socioeconomic status, BMI, PA, screen time, food consumption, health perception, attitudes toward PA, self-efficacy for PA, perception of the school environment, body image and self-esteem. Binary logistic regression analysis was used. The dropout rate was 26.8%. In the total sample and among students with an adequate BMI, there was a greater probability of dropout with an increase in age. For overweight students, increased age and socioeconomic status, and studying in the afternoon period were predictors of dropout from the intervention. Socio-demographic factors were predictors of dropout from the 'Mexa-se' intervention; the associated factors differed based on the BMI category.

Serum 25-Hydroxyvitamin D, Plasma Lipids, and Associated Gene Variants in Prepubertal Children

CONTEXT

The associations of serum 25-hydroxyvitamin D [25(OH)D] with plasma lipids remain controversial in children.

OBJECTIVE

To examine the associations and interactions of 25(OH)D and related gene variants with lipids in children.

DESIGN

Cross-sectional.

SETTING

Kuopio, Finland.

PARTICIPANTS

Population sample of 419 prepubertal white children aged 6 to 8 years.

MAIN OUTCOME MEASURES

25(OH)D, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.

RESULTS

Serum 25(OH)D was negatively associated with total cholesterol (β = -0.141, P = 0.004), LDL cholesterol (β = -0.112, P = 0.023), HDL cholesterol (β = -0.150, P = 0.002), and triglycerides (β = -0.104, P = 0.035) adjusted for age and sex. Associations of 25(OH)D with total cholesterol, LDL cholesterol, and HDL cholesterol remained after adjustment for adiposity, physical activity, sedentary behavior, diet, daylight time, and parental education. Children in the highest quartile of 25(OH)D had the lowest total cholesterol (P = 0.022) and LDL cholesterol (P = 0.026) adjusted for age and sex. Cytochrome P450 family 2 subfamily R member 1 (CYP2R1) rs12794714, CYP2R1 rs10741657, and vitamin D binding protein (DBP) rs2282679 were associated with 25(OH)D adjusted for age and sex. CYP2R1 rs12794714 was associated with total cholesterol and LDL cholesterol and C10orf88 rs6599638 with HDL cholesterol adjusted for age, sex, and 25(OH)D. The gene variants did not explain or modify the associations of 25(OH)D with lipids.

CONCLUSIONS

25(OH)D was independently and inversely associated with total cholesterol, LDL cholesterol, and HDL cholesterol. CYP2R1 rs12794714, CYP2R1 rs10741657, and DBP rs2282679 were associated with 25(OH)D. CYP2R1 rs12794714 was associated with total cholesterol and LDL cholesterol and chromosome 10 open reading frame 88 (C10orf88) rs6599638 with HDL cholesterol independent of 25(OH)D. None of the gene variants modified the associations of 25(OH)D with lipids. Further studies are needed to detect the mechanisms for the associations of 25(OH)D with lipids.

Effect of a pilot multi-component intervention on motor performance and metabolic risks in overweight/obese youth

This study evaluated the effect of a multi-component intervention on motor performance (MP) and metabolic risk markers (MRM) in overweight/obese youth. A secondary aim was to examine whether changes in MP are associated to changes in MRM. A 3-month multi-component intervention was performed, consisting of physical exercise sessions (twice/week;1h), nutritional education sessions (once/month), and parental support (twice/week). The sample included 35 volunteers (7-13 y.o), allocated to intervention (INT, n = 17) and control (CONT, n = 18) group. Variables were measured pre (T0) and post intervention (T1). Fasting blood samples were analyzed for MRM. MP tests included the measurement of health related physical fitness components and motor coordination performance (KTK battery). To assess food intake, a 24-hour recall diary was used. GLM-ANCOVA was performed. Standardized scores were calculated for the outcome variables, and multilinear regressions were applied to analyze associations between the key variables. INT group showed improvements in MP, glycolytic and hepatic profiles. After adjustments for MVPA, SB, total intake and maturational stage, negative associations between %ΔMP and %Δglycolytic (β = -.424; 95%CI:-0.343:-0.022), and %Δhepatic scores (β = -.382 95%CI:-0.001:-0.009) were observed. The intervention produced a moderate-to-high effect on the MP and some MRM. Changes in MP were inversely associated with changes in glycolytic and hepatic markers.

A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting

Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45–60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.

Impact of NFL PLAY 60 Programming on Elementary School Children's Body Mass Index and Aerobic Capacity: The NFL PLAY 60 FitnessGram Partnership Project

BACKGROUND

We examined the impact of the Fuel Up to Play 60 (FUTP60) program on children's body mass index (BMI) and aerobic capacity (AC).

METHODS

Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012-2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health-related fitness standards (ie, Needs Improvement-Health Risk [NIHR] and Healthy Fitness Zone [HFZ] categories).

RESULTS

After 1 year implementing the program, participating schools had lower proportions of boys (-4.1 ± 2.0%, p = .04) and girls (-4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (-9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05).

CONCLUSIONS

This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health-related fitness.

Effectiveness of school-based physical activity programmes on cardiorespiratory fitness in children: a meta-analysis of randomised controlled trials

Objective

To conduct a meta-analysis of randomised controlled trials aimed at testing whether school-based physical activity programmes improve cardiorespiratory fitness (CRF) in children.

Design

Systematic review with meta-analysis.

Data sources

Using keywords, we performed a computerised search in five databases: MEDLINE, EMBASE, CINAHL, Web of Science and SportDiscus.

Eligibility criteria for selecting studies

Studies that assessed the effectiveness of school-based physical activity programmes on improving CRF in children (3–12 years old). We selected interventions that included an additional physical activity programme and not only a physical activity educational component. The reference lists of selected full-text articles and systematic reviews were also searched for relevant studies. Pooled effect size (Hedges′ g) was calculated assuming a random-effects model.

Results

Twenty trials with 7287 healthy children aged 3–12 years were included in the meta-analysis. School-based physical activity interventions with aerobic games and activities were associated with a significant small increase in CRF (Hedges′ g=0.22; 95% CI 0.14 to 0.30; p<0.001). Based on subgroup analysis, the increase in CRF was significant in girls (Hedges′ g=0.25; 95% CI 0.13 to 0.37; p<0.001), but not in boys (Hedges′ g=0.02; 95% CI −0.10 to 0.14; p=0.731).

Summary

Moderate quality evidence supports the effectiveness of school-based physical activity interventions on improving CRF in children.

Trial registration number

Protocol PROSPERO registration number CRD42016050173.

Characteristics of physical activity interventions and effects on cardiorespiratory fitness in children aged 6-12 years-A systematic review

OBJECTIVES

To examine the characteristics of physical activity (PA) interventions and the effects on cardiorespiratory fitness (CRF) in healthy children based on treatment theory.

DESIGN

Systematic review.

METHODS

PubMed and Embase were searched for studies published between 2003 and 2016. Inclusion criteria were: Participants: healthy children aged 6-12.

INTERVENTIONS

interventions with activities to increase PA behaviour or physical fitness (PF) regardless of setting.

CONTROL

no or alternative intervention.

OUTCOME

exercise-based CRF measure with appropriate analysis of CRF effects.

STUDY DESIGN

randomized controlled trial. Effect size was calculated using d_ppc2 and the methodological quality of the studies was assessed using the PEDro scale.

RESULTS

Of 1002 studies screened, 23 met the inclusion criteria. Thirteen of the 23 studies found statistically significant improvements in CRF and eight studies showed medium to high effect sizes. Interventions with medium to high effect sizes focused more often on PF than PA behaviour, had slightly higher frequencies of activities and had a shorter duration than the less effective interventions.

CONCLUSIONS

The fact that thirteen studies demonstrated statistically significant improvements in CRF is promising but also emphasizes the need to keep improving research methods and the development and execution of interventions. Interventions with larger effect sizes appear to be more controlled, as they usually relied on smaller sample sizes and the components of these interventions encompassed protocolled training sessions which defined and monitored the relative training intensity intended. A duration of at least six weeks and a frequency of three to four times a week is recommended.

The Longitudinal Impact of NFL PLAY 60 Programming on Youth Aerobic Capacity and BMI

INTRODUCTION

The NFL PLAY 60 campaign has actively promoted physical activity and healthy eating in youth through programs such as the PLAY 60 Challenge and Fuel Up to PLAY 60. The purpose of the study was to evaluate the impact of NFL PLAY 60 programming on longitudinal trajectories of youth aerobic capacity and BMI.

STUDY DESIGN

Data were from the NFL PLAY 60 FitnessGram Partnership Project, a large participatory research project designed to promote physical activity and healthy eating among Kindergarten through 12th grade children and adolescents.

SETTING/PARTICIPANTS

The programming was led by teachers in school settings across 32 NFL franchise markets. A range of 50,000-100,000 students from 497 schools completed FitnessGram assessments annually starting in 2011 and continuing through 2015. The analysis was conducted in 2015.

INTERVENTION

Adoption of NFL PLAY 60 programming was encouraged but not required and the program implementation was evaluated each year. The adoption was evaluated through self-reported annual survey.

MAIN OUTCOME MEASURES

School assessments of aerobic capacity and BMI were evaluated using FitnessGram standards to calculate the percentage of students meeting the Healthy Fitness Zone for each test. Growth curve modeling was used to estimate the longitudinal trajectories.

RESULTS

About 19% of schools were classified as programming schools. Annual improvements in aerobic capacity were significantly greater in schools that participated in the programs for both girls (3.0%, p<0.01) and boys (2.9%, p<0.01) compared with non-programming schools. The annual improvements in BMI Healthy Fitness Zone achievement were also higher in girls (1.3%, p<0.05) and in boys (1.2%, p<0.05) from schools that participated in the programs versus non-participating schools. Schools that implemented the programs for the entire 4-year period tended to have better improvements in aerobic capacity than schools enrolled for only 2 or 3 years (p<0.05).

CONCLUSIONS

The results of these longitudinal analyses support the utility of the NFL PLAY 60 physical activity promotion programs for improving youth aerobic capacity and potentially helping to reverse the prevalence of overweight/obesity. However, the overall program adoption rate is low.

Evaluation of Daily Physical Activity (DPA) policy implementation in Ontario: surveys of elementary school administrators and teachers

BACKGROUND

School-based structured opportunities for physical activity can provide health-related benefits to children and youth, and contribute to international guidelines recommending 60 min of moderate-to-vigorous physical activity (MVPA) per day. In 2005, the Ministry of Education in Ontario, Canada, released the Daily Physical Activity (DPA) policy requiring school boards to "ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time". This paper reports on the first provincial study evaluating implementation fidelity to the DPA policy in Ontario elementary schools and classrooms. Using an adapted conceptual framework, the study also examined associations between implementation of DPA and a number of predictors in each of these respective settings.

METHODS

Separate cross-sectional online surveys were conducted in 2014 with Ontario elementary school administrators and classroom teachers, based on a representative random sample of schools and classrooms. An implementation fidelity score was developed based on six required components of the DPA policy. Other survey items measured potential predictors of implementation at the school and classroom levels. Descriptive analyses included frequency distributions of implementation fidelity and predictor variables. Bivariate analyses examining associations between implementation and predictors included binary logistic regression for school level data and generalized linear mixed models for classroom level data, in order to adjust for school-level clustering effects.

RESULTS

Among administrators, 61.4 % reported implementation fidelity to the policy at the school level, while 50.0 % of teachers reported fidelity at the classroom level. Several factors were found to be significantly associated with implementation fidelity in both school and classroom settings including: awareness of policy requirements; scheduling; monitoring; use of resources and supports; perception that the policy is realistic and achievable; and specific barriers to implementation.

CONCLUSIONS

Findings from the surveys indicate incomplete policy implementation and a number of factors significantly associated with implementation fidelity. The results indicate a number of important implications for policy, practice and further research, including the need for additional research to monitor implementation and its predictors, and assess the impacts of study recommendations and subsequent outcomes of a reinvigorated DPA moving forward.

Design and Evaluation of the NFL PLAY 60 FITNESSGRAM Partnership Project

This article describes the conceptual design and evaluation strategies used in the NFL PLAY 60 FITNESSGRAM Partnership Project, a large participatory research network focused on building effective school physical education programming. The article summarizes the unique participatory design, recruitment methods, programming strategies, and analytical plans used to evaluate this large project. The study provides unique insight into how to effectively deliver large-scale school-based physical fitness and physical activity programming to support and enhance physical education programming in schools.

Effectiveness of a 5-year school-based intervention programme to reduce adiposity and improve fitness and lifestyle in Indian children; the SYM-KEM study

DESIGN

Non-randomised non-blinded school-based intervention study.

SETTING

Two schools in the cities of Pune and Nasik, India.

PARTICIPANTS

The intervention group comprised children attending a Pune school from 7-10 years until 12-15 years of age. Two control groups comprised children of the same age attending a similar school in Nasik, and children in the Pune intervention school but aged 12-15 years at the start of the study.

INTERVENTION

A 5-year multi-intervention programme, covering three domains: physical activity, diet and general health, and including increased extracurricular and intracurricular physical activity sessions; daily yoga-based breathing exercises; making physical activity a 'scoring' subject; nutrition education; healthier school meals; removal of fast-food hawkers from the school environs; and health and nutrition education for teachers, pupils and families.

MAIN OUTCOME MEASURES

Body mass index (BMI), waist circumference, physical fitness according to simple tests of strength, flexibility and endurance; diet; and lifestyle indicators (time watching TV, studying and actively playing).

RESULTS

After 5 years the intervention children were fitter than controls in running, long jump, sit-up and push-up tests (p<0.05 for all). They reported spending less time sedentary (watching TV and studying), more time actively playing and eating fruit more often (p<0.05). The intervention did not reduce BMI or the prevalence of overweight/obesity, but waist circumference was lower than in the Pune controls (p=0.004).

CONCLUSIONS

It was possible to achieve multiple health-promoting changes in an academically competitive Indian school. These changes resulted in improved physical fitness, but had no impact on the children's BMI or on the prevalence of overweight/obesity.

Assessing the usefulness of systematic reviews for policymakers in public health: A case study of overweight and obesity prevention interventions

OBJECTIVE

Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers.

METHOD

We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications.

RESULTS

Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0).

CONCLUSION

SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.

Nurse-Led School-Based Child Obesity Prevention

School-based childhood obesity prevention programs have grown in response to reductions in child physical activity (PA), increased sedentariness, poor diet, and soaring child obesity rates. Multiple systematic reviews indicate school-based obesity prevention/treatment interventions are effective, yet few studies have examined the school nurse role in obesity interventions. Building on a previous study, this study examines a refined health messaging (Let’s Go 5-2-1-0) program delivered to fourth and fifth graders ( n = 72) by a school nurse with reinforcement on-site health coaching by senior nursing students. Two nursing schools and two elementary schools participated. Measures of PA, body mass index percentile, and self-reported health habits were collected at baseline (School A, September 2009 and School B, January 2010) and end of year (April 2010 for both schools). Findings included statistically significant increases in PA levels and improvements in child-reported health habits. School nurses can influence obesity prevention. Further research on adoption of school nurse–led obesity interventions is warranted.

A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China

BACKGROUND

The prevalence of obesity among children and adolescents has been rapidly rising in Mainland China in recent decades, both in urban and rural areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited rigid data regarding children and adolescent overweight prevention in China are available. A national random controlled school-based obesity intervention program was developed in the mainland of China.

METHODS/DESIGN

The study was designed as a national multi-centered cluster randomized controlled trial involving more than 70,000 children and adolescents aged 7-18 years from 7 provinces in China. In each center, about 12-16 primary and secondary schools, with totally at least 10000 participants were randomly selected (Primary: Secondary = 1:1). All of the selected schools were randomly allocated to either intervention or control group (Intervention: Control = 1:1).The multi-components school-based and family-involved scheme was conducted within the intervention group for 9 month, while students in the control group followed their usual health practice. The intervention consisted of four components: a) Create supportive school and family environment, b) Health lifestyles education and related compulsory physical activities, c) Instruct and promote school physical education, d) Self-monitor obesity related behaviors. Four types of outcomes including anthropometric, behavioral, blood chemical and physical fitness were measured to assess the effectiveness of the intervention program.

DISCUSSION

This is the first and largest multi-centered school-based obesity intervention program with the consideration of geographical and social-demographic characteristics of the rapidly increased obesity prevalence of Chinese children and adolescent. The intervention is based on Social Cognitive Theory and Social-Ecological Model of Health, and follows a stepwise approach guided by PRECEDE-PROCEED (P-P) Model and Intervention Map. The results of and lesson learned from this study will help guide future school-based national childhood obesity prevention programs in Mainland China.

TRIAL REGISTRATION

January 22, 2015;

REGISTRATION NUMBER

NCT02343588.

Effects of exercise on BMI z-score in overweight and obese children and adolescents: a systematic review with meta-analysis

BACKGROUND

Overweight and obesity are major public health problems in children and adolescents. The purpose of this study was to conduct a systematic review with meta-analysis to determine the effects of exercise (aerobic, strength or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.

METHODS

Studies were included if they were randomized controlled exercise intervention trials ≥ 4 weeks in overweight and obese children and adolescents 2 to 18 years of age, published in any language between 1990-2012 and in which data were available for BMI z-score. Studies were retrieved by searching eleven electronic databases, cross-referencing and expert review. Two authors (GAK, KSK) selected and abstracted data. Bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Exercise minus control group changes were calculated from each study and weighted by the inverse of the variance. All results were pooled using a random-effects model with non-overlapping 95% confidence intervals (CI) considered statistically significant. Heterogeneity was assessed using Q and I2 while funnel plots and Egger's regression test were used to assess for small-study effects. Influence and cumulative meta-analysis were performed as well as moderator and meta-regression analyses.

RESULTS

Of the 4,999 citations reviewed, 835 children and adolescents (456 exercise, 379 control) from 10 studies representing 21 groups (11 exercise, 10 control) were included. On average, exercise took place 4 x week for 43 minutes per session over 16 weeks. Overall, a statistically significant reduction equivalent to 3% was found for BMI z-score (Χ¯, -0.06, 95% CI, -0.09 to -0.03; Q = 24.9, p = 0.01; I(2)=59.8%). No small-study effects were observed and results remained statistically significant when each study was deleted from the model once. Based on cumulative meta-analysis, results have been statistically significant since 2009. None of the moderator or meta-regression analyses were statistically significant. The number-needed-to treat was 107 with an estimated 116,822 million obese US children and adolescents and approximately 1 million overweight and obese children and adolescents worldwide potentially improving their BMI z-score by participating in exercise.

CONCLUSIONS

Exercise improves BMI z-score in overweight and obese children and adolescents and should be recommended in this population group. However, a need exists for additional studies on this topic.

Physical activity, psychosocial and perceived environmental factors in adolescents from Northeast Brazil

The aim of this study was to evaluate the association between levels of physical activity, psychosocial and perceived environmental factors in adolescents from Northeastern Brazil. A cross-sectional epidemiologic study was conducted with 2,859 adolescents enrolled in secondary schools (57.8% females; mean = 16.5 years; SD = 1.2) in the city of João Pessoa, Paraíba State, Brazil. The following physical activity correlates were measured: attitude, self-efficacy, social support from friends and parents, and perceived environmental characteristics. Physical activity was measured using a questionnaire. Multivariable ordinal logistic regression with proportional odds model analysis showed that the following factors are positively related to physical activity levels in adolescents: attitude, self-efficacy, as well as social support from parents and friends. Physical activity intervention programs should increase self-efficacy and social support from parents and friends, as well as a positive attitude toward physical activity.

Physical activity and sedentary behaviour in relation to cardiometabolic risk in children: cross-sectional findings from the Physical Activity and Nutrition in Children (PANIC) Study

Background

Lower levels of physical activity (PA) and sedentary behaviour (SB) have been associated with increased cardiometabolic risk among children. However, little is known about the independent and combined associations of PA and SB as well as different types of these behaviours with cardiometabolic risk in children. We therefore investigated these relationships among children.

Methods

The subjects were a population sample of 468 children 6–8 years of age. PA and SB were assessed by a questionnaire administered by parents and validated by a monitor combining heart rate and accelerometry measurements. We assessed body fat percentage, waist circumference, blood glucose, serum insulin, plasma lipids and lipoproteins and blood pressure and calculated a cardiometabolic risk score using population-specific Z-scores and a formula waist circumference + insulin + glucose + triglycerides - HDL cholesterol + mean of systolic and diastolic blood pressure. We analysed data using multivariate linear regression models.

Results

Total PA was inversely associated with the cardiometabolic risk score (β = -0.135, p = 0.004), body fat percentage (β = -0.155, p < 0.001), insulin (β = -0.099, p = 0.034), triglycerides (β = -0.166, p < 0.001), VLDL triglycerides (β = -0.230, p < 0.001), VLDL cholesterol (β = -0.168, p = 0.001), LDL cholesterol (β = -0.094, p = 0.046) and HDL triglycerides (β = -0.149, p = 0.004) and directly related to HDL cholesterol (β = 0.144, p = 0.002) adjusted for age and gender. Unstructured PA was inversely associated with the cardiometabolic risk score (β = -0.123, p = 0.010), body fat percentage (β = -0.099, p = 0.027), insulin (β = -0.108, p = 0.021), triglycerides (β = -0.144, p = 0.002), VLDL triglycerides (β = -0.233, p < 0.001) and VLDL cholesterol (β = -0.199, p < 0.001) and directly related to HDL cholesterol (β = 0.126, p = 0.008). Watching TV and videos was directly related to the cardiometabolic risk score (β = 0.135, p = 0.003), body fat percentage (β = 0.090, p = 0.039), waist circumference (β = 0.097, p = 0.033) and systolic blood pressure (β = 0.096, p = 0.039). Resting was directly associated with the cardiometabolic risk score (β = 0.092, p = 0.049), triglycerides (β = 0.131, p = 0.005), VLDL triglycerides (β = 0.134, p = 0.009), VLDL cholesterol (β = 0.147, p = 0.004) and LDL cholesterol (β = 0.105, p = 0.023). Other types of PA and SB had less consistent associations with cardiometabolic risk factors.

Conclusions

The results of our study emphasise increasing total and unstructured PA and decreasing watching TV and videos and other sedentary behaviours to reduce cardiometabolic risk among children.

Trial registration

ClinicalTrials.gov Identifier: NCT01803776.