1
|
Kaur N, Gupta M, Chakrapani V, Khan F, Malhi P, Kiran T, Grover S. Effectiveness of a program to lower unwanted media screens among 2-5-year-old children: a randomized controlled trial. Front Public Health 2024; 12:1304861. [PMID: 38966696 PMCID: PMC11223730 DOI: 10.3389/fpubh.2024.1304861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/19/2024] [Indexed: 07/06/2024] Open
Abstract
Background Limited interventions exist on reducing unwanted screen time (ST) among children from low- and middle-income countries (LMICs), so we developed and assessed the effectiveness of the program to lower unwanted media screen time (PLUMS) among children aged 2-5 years in Chandigarh, Union Territory, North India. Methods An open-label randomized control parallel group trial per CONSORT guidelines was conducted among randomly selected 340 families with children aged 2-5 (±3 months) years in Chandigarh, India. PLUMS was implemented at the family level with a focus on modifying the home media environment and targeted individual-level interventions using parent and child modules for 2 months. A post-intervention (immediately) and a follow-up assessment after 6 months was done. During the follow-up period, the interaction was done passively via WhatsApp groups. The control group received routine healthcare services. Validated and standardized tools, including a digital screen exposure questionnaire with a physical activity component, preschool child behavior checklist, and sleep disturbance scale for children, were used to collect data at baseline, post-intervention, and follow-up periods. The primary outcome was the mean difference in ST (minutes/day) among children in the intervention group versus the control group. Generalized estimating equation (GEE) analysis was performed to adjust for clustering. Results An equal number of families (n = 170) were randomly assigned to the intervention and control arms. In the post-intervention assessment, 161 and 166 families continued while, at the follow-up assessment, 154 and 147 were in the intervention and control arm, respectively. The mean difference in ST on a typical day [27.7 min, 95% Confidence Interval (CI) 5.1, 50.3] at the post-intervention assessment significantly (p < 0.05) decreased in the intervention (102.6 ± 98.5 min) arm as compared with the control (130.3 ± 112.8 min) arm. A significant reduction in ST (β = -35.81 min, CI -70.6, -1.04) from baseline (β = 123.1 min) to follow-up phase (β = 116 min) was observed in GEE analysis. The duration of physical activity increased both at post-intervention (β = 48.4 min, CI = +6.6, +90.3) and follow-up (β = 73.4 min, CI = 36.2, 110.5) assessments in the intervention arm. Conclusion The PLUMS intervention significantly reduced the children's mean ST on a typical day and increased the physical activity immediately post-intervention and during the 6-month follow-up period. These results might guide the policymakers to include strategies in the national child health programs in the Southeast Asia Region to reduce unwanted ST.Clinical trial registration: https://clinicaltrials.gov/, identifier CTRI/2017/09/009761.
Collapse
Affiliation(s)
- Nimran Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Firoz Khan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Tanvi Kiran
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | |
Collapse
|
2
|
Padgett L, Stevens J, Summerbell C, Burton W, Stamp E, McLarty L, Schofield H, Bryant M. Childhood obesity prevention trials: A systematic review and meta-analysis on trial design and the impact of type 1 error. Obes Rev 2024; 25:e13736. [PMID: 38529530 DOI: 10.1111/obr.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Effect sizes from previously reported trials are often used to determine the meaningful change in weight in childhood obesity prevention interventions because information on clinically meaningful differences is lacking. Estimates from previous trials may be influenced by statistical significance; therefore, it is important that they have a low risk of type 1 error. A systematic review and meta-analysis were conducted to report on the design of child obesity prevention randomized controlled trials and effectiveness according to risk of type 1 error. Eighty-four randomized controlled trials were identified. A large range of assumptions were applied in the sample size calculations. The most common primary outcome was BMI, with detectable effect size differences used in sample size calculations ranging from 0.25 kg/m2 (followed up at 2 years) to 1.1 kg/m2 (at 9 months) and BMI z-score ranging from 0.1 (at 4 years) to 0.67 (at 3 years). There was no consistent relationship between low risk of type 1 error and reports of higher or lower effectiveness. Further clarity of the size of a meaningful difference in weight in childhood obesity prevention trials is required to support evaluation design and decision-making for intervention and policy. Type 1 error risk does not appear to impact effect sizes in a consistent direction.
Collapse
Affiliation(s)
- Louise Padgett
- Department of Health Sciences, University of York, York, UK
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, UK
| | - Elizabeth Stamp
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Laura McLarty
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Holly Schofield
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, UK
| |
Collapse
|
3
|
Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
Collapse
Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Olesen LG, Grøntved A, Brønd JC, Hestbæk L, Kristensen PL. Effectiveness of a Preschool Motor Skill Intervention on Body Mass Index and Movement Behavior: 6-, 18-, and 30-Month Findings From a Cluster Randomized Controlled Trial. Pediatr Exerc Sci 2024:1-16. [PMID: 38653455 DOI: 10.1123/pes.2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To study the effectiveness of a preschool staff-delivered motor skills intervention on body composition and physical activity over a 2.5-year time frame. METHODS In this pragmatic parallel cluster randomized controlled trial (16 preschools), outcome data were collected after 6 (body composition only), 18, and 30 months of intervention. The main physical activity outcomes were accelerometer behavior measures summarizing the total percentage of child daily movement (walk, run, cycle, and standing that included minor movements) and preschool movement during preschool attendance. To estimate between-group mean differences in outcomes, mixed-linear regression analyses including baseline value of the selected outcome and a treatment × time interaction term as a fixed effect were applied. In addition, the baseline preschool and child were included as a random effect. RESULTS For body mass index, a total of 437 children (90%) had at least one valid baseline and one follow-up assessment. The corresponding numbers for preschool movement and daily movement were 163 (55%) and 146 (49%), respectively. No significant between-group mean difference was identified for body mass index, waist-to-height ratio, or any physical activity outcomes. CONCLUSION Overall, this preschool motor skills intervention had no effect on either child anthropometry or physical activity, consistent with previous studies.
Collapse
Affiliation(s)
- Line Grønholt Olesen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense,Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital Skejby, Aarhus,Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense,Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense,Denmark
| | - Lise Hestbæk
- The Chiropractic Knowledge Hub and Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense,Denmark
| | - Peter Lund Kristensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense,Denmark
| |
Collapse
|
5
|
Treviño-Peña R, Romero Z, Fuentes JC, Cortez KE, Alanis E, Alvarenga JCL. A Coordinated School Health Program Effect on Cardiorespiratory Fitness of South Texas Preschool Children: A Cluster Randomized Trial. THE JOURNAL OF SCHOOL HEALTH 2024; 94:336-345. [PMID: 38252805 DOI: 10.1111/josh.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The purpose of this study was to assess the effects of the Bienestar/NEEMA Coordinated School Health Program (BN CSHP) on cardiorespiratory fitness (CRF) of preschool children. METHODS A cluster randomized trial was conducted of preschools in South Texas. Of 48 eligible schools, 28 were randomly assigned (14 intervention, 14 control). Family demographics and household health characteristics were collected from parents and CRF from children. Generalized linear mixed model (GLMM) was used to analyze the data. RESULTS Family demographics, household health characteristics, and children's weight, obesity prevalence, and sedentary activity of the control group were similar to the intervention group at baseline. After adjusting for covariates, the number of laps ran by children in the control group increased by 23% (CI: -5% to 60%) per each data collection period compared with 53% (CI: 7% to 119%) in the intervention group. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY State mandates, parent engagement, and funding are key for designing effective health and Physical Education (PE) programs. CONCLUSION Children in the BN CSHP, compared to those in the control group, had a significantly higher increase in their CRF. This finding is important because of the health benefits of CRF in children. CLINICALTRIALS gov Identifier: NCT05501392.
Collapse
Affiliation(s)
| | - Zasha Romero
- University of Texas-Rio Grande Valley, Edinburgh, TX
| | | | | | | | - Juan C L Alvarenga
- Division of Population Health & Biostatistics, University of Texas-Rio Grande Valley, Edinburgh, TX
| |
Collapse
|
6
|
Sun S, Chen C. The Effect of Sports Game Intervention on Children's Fundamental Motor Skills: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:254. [PMID: 38397366 PMCID: PMC10888172 DOI: 10.3390/children11020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The purpose of the present study was to carry out a systematic review and a meta-analysis determining the effects of sports game intervention on fundamental motor skills in children. This paper presented a systematic review from 2001 to 2020, including the databases of Web of Science, EBSCO, Science, PubMed and Springer. (1) Participants comprised 1701 children age 3-12 years; (2) sports game interventions were investigated; (3) only studies using a Test of Gross Motor Skills assessment were included; (4) RCT were chosen as the study design to assess the impact of sports game interventions on children's motor skills; (5) only culture-based sports game studies in the English and Chinese language were included. Two researchers independently reviewed and assessed the eligibility criteria. Out of the initial 1826 references, 12 studies with a total of 1608 participants were included in the meta-analysis. All interventions were implemented in preschool (kindergarten) or primary school populations, and all studies followed a randomized controlled trial design. The results demonstrated significantly superior development of fundamental motor skills in the intervention groups compared to the control groups (standardized mean difference = 0.30, p < 0.0001). The methodological quality of the included studies ranged from fair to excellent, and no evidence of publication bias was observed. Among them, the 12-week sports game intervention of 35 min each time three to four times a week had a better intervention effect, promoting children's physical health and fundamental motor skills.
Collapse
Affiliation(s)
| | - Changzhou Chen
- School of Physical Education, Shanghai University of Sport, Shanghai 200438, China;
| |
Collapse
|
7
|
Al-walah MA, Donnelly M, Heron N. Barriers, enablers and motivators of the "I'm an active Hero" physical activity intervention for preschool children: a qualitative study. Front Pediatr 2024; 12:1333173. [PMID: 38357506 PMCID: PMC10864600 DOI: 10.3389/fped.2024.1333173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Background Insufficient physical activity (PA) in early childhood is linked to adverse health outcomes and a heightened risk of obesity. Successful PA programmes often require input from key stakeholders, such as parents and educators. However, research on stakeholders' perspectives regarding PA programmes for preschool children is limited, impeding effective programme design and implementation. Objectives This study aims to explore the perspectives of key stakeholders to gain insights into the challenges, facilitators, and motivators that influence the planning, execution, and sustainability of the "I'm an Active Hero (IAAH) intervention component," a preschool-based initiative designed to promote PA among young children. Methods Semi-structured interviews were conducted in Saudi Arabia with individual preschool principals (n = 2), and focus group discussions were held, respectively, with preschool staff members (n = 4, all female) and parents (4 mothers, 5 fathers). Results A thematic analysis identified four main themes: (1) Barriers to parental involvement in preschool PA interventions, such as time constraints, lack of flexibility, limited space, and a shortage of trained staff; (2) Risks and benefits of children's programme participation; (3) Motivators including rewards, non-financial incentives, and concerns about childhood obesity and a sedentary lifestyle; (4) Facilitating factors for overcoming barriers, including staff training, time reallocation, staff coordination, space optimization, non-financial incentives, and sustaining partnerships. Conclusion This study's findings are crucial for childcare professionals, preschools, education authorities, and policymakers, offering valuable insights for future research. However, further collaboration with key stakeholders is essential to enhance individual attitudes and preschool policies for effective intervention implementation.
Collapse
Affiliation(s)
- Mosfer A. Al-walah
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Neil Heron
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Medicine, Keele University, Newcastle-Under-Lyme, Staffordshire, England
| |
Collapse
|
8
|
Godoy-Cumillaf A, Fuentes-Merino P, Giakoni-Ramírez F, Duclos-Bastías D, Bruneau-Chávez J, Merellano-Navarro E. The Effects of a Physical Activity Intervention on Adiposity, Physical Fitness and Motor Competence: A School-Based, Non-Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2024; 11:137. [PMID: 38275447 PMCID: PMC10814922 DOI: 10.3390/children11010137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 01/27/2024]
Abstract
Evidence suggests that early physical activity interventions are a means of preventing childhood obesity and are more effective when delivered in a school setting and based on the ecological model. Therefore, the present study aims to determine the effect of a multicomponent intervention based on the ecological model on adiposity, physical fitness and motor competence in children aged 4 to 5 years. METHODS This study is a non-randomized controlled trial involving 173 children from Chile. The intervention was based on an ecological model and consisted of a physical activity program with three simultaneous parts, affecting intra- and interpersonal dimensions. The adiposity index, body mass index and waist circumference were measured. For physical fitness, muscle strength in the lower part, speed/agility and cardiorespiratory fitness were measured. Motor competence was assessed using catching, aiming and dynamic and static balance tests. RESULTS After the intervention, there was no reduction in adiposity indices; in the intervention group, body mass index increased significantly with a high effect size. The intervention group showed significant differences in physical fitness in the components of muscle strength in the lower part (p = 0.000) and speed/agility (p = 0.002). For motor competence, the intervention group showed significant improvements in most components. CONCLUSIONS The multicomponent intervention did not reduce adiposity indices; however, it caused significant improvements in the physical fitness and motor competence components, so it seems prudent to continue implementing it, given the benefits that adequate levels of motor competence and physical fitness bring to children's health, both in the short and long term.
Collapse
Affiliation(s)
- Andrés Godoy-Cumillaf
- Grupo de Investigación en Educación Física, Salud y Calidad de Vida (EFISAL), Facultad de Educación, Universidad Autónoma de Chile, Temuco 4780000, Chile; (A.G.-C.); (P.F.-M.)
| | - Paola Fuentes-Merino
- Grupo de Investigación en Educación Física, Salud y Calidad de Vida (EFISAL), Facultad de Educación, Universidad Autónoma de Chile, Temuco 4780000, Chile; (A.G.-C.); (P.F.-M.)
| | - Frano Giakoni-Ramírez
- Faculty of Education and Social Sciences, Universidad Andres Bello, Las Condes, Santiago 7550000, Chile;
| | - Daniel Duclos-Bastías
- Escuela de Educación Física, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340000, Chile;
- IGOID Research Group, Physical Activity and Sport Science Department, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - José Bruneau-Chávez
- Departamento de Educación Física, Deportes y Recreación, Universidad de la Frontera, Temuco 4811230, Chile;
| | - Eugenio Merellano-Navarro
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca 3530000, Chile
| |
Collapse
|
9
|
Olsen NJ, Østergaard JN, Bjerregaard LG, Høy TV, Kierkegaard L, Michaelsen KF, Sørensen TIA, Grønbaek MK, Bruun JM, Heitmann BL. A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention. Obes Rev 2024; 25:e13641. [PMID: 37871966 DOI: 10.1111/obr.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 10/25/2023]
Abstract
Primary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.
Collapse
Affiliation(s)
- Nanna J Olsen
- Research Unit for Dietary Studies, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jane N Østergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Lise G Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Teresa V Høy
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lene Kierkegaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Thorkild I A Sørensen
- Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten K Grønbaek
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jens M Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish National Center for Obesity, Aarhus, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Boden Group, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
- Section of General Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Diamantis DV, Shalit A, Katsas K, Zioga E, Zota D, Kastorini CM, Veloudaki A, Kouvari M, Linos A. Improving Children's Lifestyle and Quality of Life through Synchronous Online Education: The Nutritional Adventures School-Based Program. Nutrients 2023; 15:5124. [PMID: 38140383 PMCID: PMC10745706 DOI: 10.3390/nu15245124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
The early introduction of effective nutritional educational programs is pivotal for instilling sustainable healthy behaviors. The present work aims to present a best practice example of a nutrition and overall lifestyle school-based training program, the Nutritional Adventures ("Diatrofoperipeteies"). Conducted during 2020-2022 in Greek primary schools, this synchronous, online educational initiative included two 1-school-hour activities with a nutrition instructor. Additionally, schools were randomly assigned to supplementary "at-home" supported-by-parents or "in-class" supported-by-educators educational activities. In total, n = 12,451 students of 84 primary schools participated. Parent-completed questionnaires were selected in the recruitment and post-intervention phase (40% participation rate); overall, the working sample was n = 1487 students. In the post-intervention phase, a significant increase in Mediterranean diet adherence was observed (KIDMED score: mean increment = 0.25 units; p < 0.001), particularly fruit and vegetable consumption. Time spent on physical activity increased, while screen time decreased. Students' total quality of life significantly improved (PedsQL; mean increment = 1.35 units; p < 0.001), including on all of its subscales (physical, emotional, social, and school function). Supplementary educational activities that were supported by educators rather than parents yielded a more favorable impact on students' lifestyle and quality of life. The Nutritional Adventures program can be regarded as a successful initiative in primary schools, yielding immediate advantages that extend beyond promoting healthy dietary habits.
Collapse
Affiliation(s)
- Dimitrios V. Diamantis
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | - Almog Shalit
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantinos Katsas
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelia Zioga
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | - Dina Zota
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | | | - Afroditi Veloudaki
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| | - Matina Kouvari
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Athena Linos
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece; (D.V.D.); (A.S.); (K.K.); (E.Z.); (D.Z.); (A.V.); (A.L.)
| |
Collapse
|
11
|
Grady A, Jackson J, Wolfenden L, Lum M, Yoong SL. Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review. Public Health Nutr 2023; 26:3211-3229. [PMID: 37990443 PMCID: PMC10755435 DOI: 10.1017/s1368980023002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Early childhood education and care (ECEC) is a recommended setting for the delivery of health eating interventions 'at scale' (i.e. to large numbers of childcare services) to improve child public health nutrition. Appraisal of the 'scalability' (suitability for delivery at scale) of interventions is recommended to guide public health decision-making. This study describes the extent to which factors required to assess scalability are reported among ECEC-based healthy eating interventions. DESIGN Studies from a recent Cochrane systematic review assessing the effectiveness of healthy eating interventions delivered in ECEC for improving child dietary intake were included. The reporting of factors of scalability was assessed against domains outlined within the Intervention Scalability Assessment Tool (ISAT). The tool recommends decision makers consider the problem, the intervention, strategic and political context, effectiveness, costs, fidelity and adaptation, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability. Data were extracted by one reviewer and checked by a second reviewer. SETTING ECEC. PARTICIPANTS Children 6 months to 6 years. RESULTS Of thirty-eight included studies, none reported all factors within the ISAT. All studies reported the problem, the intervention, effectiveness and the delivery workforce and setting. The lowest reported domains were intervention costs (13 % of studies) and sustainability (16 % of studies). CONCLUSIONS Findings indicate there is a lack of reporting of some key factors of scalability for ECEC-based healthy eating interventions. Future studies should measure and report such factors to support policy and practice decision makers when selecting interventions to be scaled-up.
Collapse
Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Melanie Lum
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Victoria, Australia
| |
Collapse
|
12
|
Hao L, Fan Y, Zhang X, Rong X, Sun Y, Liu K. Functional physical training improves fitness and cognitive development in 4~5 years old children. Front Psychol 2023; 14:1266216. [PMID: 38034291 PMCID: PMC10684932 DOI: 10.3389/fpsyg.2023.1266216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Development of physical and cognitive function is very critical in 4~5 years children. It has been addressed in this research if the 18 weeks of specific functional training with or without cognitive training can be effective on improving fitness and cognitive development in 4~5 years preschool children. Methods A total of 126 preschool children in the 4~5 age range were selected as participants and randomly assigned to one of four groups: the control group (C), the functional physical training group (P), the cognitive training group (CT), and the functional physical training combined with cognitive training group (PCT). Results The results revealed significant pre/post differences in body height and weight among all four groups of children. Furthermore, there was no significant difference in physical fitness between the C group and the CT group after the intervention. However, the children in the P group and the PCT group showed significant improvements in three indicators including standing long jump, continuous jump, and 10-meter shuttle running. Additionally, the children in P group, CT group, and the PCT group demonstrated significant improvement in simple reaction time, attention, and spatial memory. No significant cognitive improvement was found in C group. Conclusion Functional physical training with or without cognitive intervention can promote both physical fitness and cognitive development in children aged 4~5 years. Cognitive training alone can significantly improve cognitive function but not physical. Therefore, functional physical training can be used alone to improve the physical and cognitive abilities for aged 4~5 years old children.
Collapse
Affiliation(s)
- Lei Hao
- College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Yongzhao Fan
- Department of Physical Education, Henan Normal University, Xinxiang, Henan, China
| | - Xiaojuan Zhang
- Graduate School, Capital University of Physical Education and Sports, Beijing, China
| | - Xiangjiang Rong
- Graduate School, Capital University of Physical Education and Sports, Beijing, China
| | - Youping Sun
- College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Kun Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Brain Peace Science Foundation, New Haven, CT, United States
| |
Collapse
|
13
|
Yoong SL, Lum M, Wolfenden L, Jackson J, Barnes C, Hall AE, McCrabb S, Pearson N, Lane C, Jones JZ, Nolan E, Dinour L, McDonnell T, Booth D, Grady A. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years. Cochrane Database Syst Rev 2023; 8:CD013862. [PMID: 37606067 PMCID: PMC10443896 DOI: 10.1002/14651858.cd013862.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health. OBJECTIVES To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions. SEARCH METHODS We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3). AUTHORS' CONCLUSIONS ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Melanie Lum
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Alix E Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jannah Z Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Lauren Dinour
- College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Therese McDonnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Debbie Booth
- Auchmuty Library, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| |
Collapse
|
14
|
Bermejo-Cantarero A, Sánchez-López M, Álvarez-Bueno C, Redondo-Tébar A, García-Hermoso A, Martínez-Vizcaino V. Are Physical Activity Interventions Effective in Improving Health-Related Quality of Life in Children and Adolescents? A Systematic Review and Meta-Analysis. Sports Health 2023:19417381231190885. [PMID: 37608692 DOI: 10.1177/19417381231190885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
CONTEXT Physical activity (PA) interventions improve well-being and positive mental health in children and adolescents, but the results of previous systematic reviews included participants with chronic medical conditions and did not accurately assess the multidimensional nature of health-related quality of life (HRQoL). OBJECTIVE The aims of this meta-analysis were to (1) evaluate the effects of PA interventions on several domains of HRQoL in healthy <18-year-olds and (2) examine the effectiveness of interventions on HRQoL according to whether they were successful in increasing PA, the type of intervention delivered, and the duration of the intervention. DATA SOURCES PubMed (Medline), EMBASE, the Cochrane Library, SCIELO, SPORTDiscus, and PEDro databases were systematically searched from inception to September 30, 2022. STUDY SELECTION Experimental studies that examined the effectiveness of PA interventions on HRQoL participants aged <18 years. STUDY DESIGN Systematic review with meta-analysis and meta-regression. LEVEL OF EVIDENCE Level 1. METHODS Random-effects models were used to calculate pooled effect size (ES) for total HRQoL score and its dimensions. Subgroup analyses were conducted to examine the effect of PA program characteristics. RESULTS A total of 17 studies were included. Pooled ES (95% CI) estimations were as follows: 0.179 (0.045, 0.002) for total HRQoL score, 0.192 (0.077, 0.306) for physical well-being, 0.158 (0.080, 0.237) for psychological well-being, 0.118 (0.044, 0.192) for autonomy and parent relation, 0.135 (0.043, 0.227) for social support and peers, and 0.129 (-0.013, 0.270) for school environment. Subgroup analyses suggested there were no differences in the effectiveness of the interventions by category of PA increase or by type and duration of intervention. CONCLUSION Exercise interventions are an effective strategy for improving overall HRQoL and its most significant domains in children and adolescents.
Collapse
Affiliation(s)
- Alberto Bermejo-Cantarero
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
- Faculty of Nursing, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Mairena Sánchez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
- School of Education, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción 2024, Paraguay
| | - Andres Redondo-Tébar
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
| | - Vicente Martínez-Vizcaino
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| |
Collapse
|
15
|
Yoong SL, Lum M, Wolfenden L, Jackson J, Barnes C, Hall AE, McCrabb S, Pearson N, Lane C, Jones JZ, Dinour L, McDonnell T, Booth D, Grady A. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years. Cochrane Database Syst Rev 2023; 6:CD013862. [PMID: 37306513 PMCID: PMC10259732 DOI: 10.1002/14651858.cd013862.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health. OBJECTIVES To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions. SEARCH METHODS We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS: We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3). AUTHORS' CONCLUSIONS ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Melanie Lum
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Alix E Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jannah Z Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Lauren Dinour
- College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Therese McDonnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Debbie Booth
- Auchmuty Library, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| |
Collapse
|
16
|
Buckler EJ, Faulkner GE, Beauchamp MR, Rizzardo B, DeSouza L, Puterman E. A Systematic Review of Educator-Led Physical Literacy and Activity Interventions. Am J Prev Med 2023; 64:742-760. [PMID: 37085246 DOI: 10.1016/j.amepre.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Early childhood is a key time for the development of physical activity behaviors and physical literacy. A growing proportion of children spend a significant portion of their daytime in early childhood education and care settings where an early childhood educator cares for them. This systematic review (PROSPERO CRD42018087249) aimed to identify the differences between effective and noneffective educator-led interventions with a goal to improve physical literacy and/or physical activity in children aged 3-5 years in early childhood education and care settings. METHODS Interventions were included if they aimed to improve at least 1 physical literacy component or physical activity time in children aged 2-6 years through educator training. MEDLINE, Embase, CINAHL, ERIC, Australian Education Index, and Sport Discus were searched in March 2018 and April 2021. Risk of bias was assessed through a modified Cochrane assessment tool. RESULTS Data from 51 studies were analyzed in 2021 and 2022 and summarized narratively. Thirty-seven interventions aimed to promote physical activity, and 28 sought to promote physical literacy; 54% and 63% of these were effective, respectively. Interventions that were underpinned by theory, included ongoing support, or measured intervention fidelity were more effective, especially when all 3 were done. DISCUSSION This review was limited by a high risk of bias and inconsistency in reporting results across interventions. Reporting physical activity by minutes per hour and reporting both sub and total scores in physical literacy assessments will allow for greater cross-comparison between trials. Future training of educators should be underpinned by theory and incorporate ongoing support and objective fidelity checks.
Collapse
Affiliation(s)
- E Jean Buckler
- School of Exercise Science, Physical & Health Education, Faculty of Education, University of Victoria, Victoria, British Columbia, Canada; Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.
| | - Guy E Faulkner
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark R Beauchamp
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth Rizzardo
- Department of Kinesiology, Langara College, Vancouver, British Columbia, Canada
| | - Liz DeSouza
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eli Puterman
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Kracht CL, Burkart S, Flanagan EW, Melnick E, Luecking C, Neshteruk C. Policy, system, and environmental interventions addressing obesity and diet-related outcomes in early childhood education settings: A systematic review. Obes Rev 2023; 24:e13547. [PMID: 36601716 PMCID: PMC10214414 DOI: 10.1111/obr.13547] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
Early childhood education (ECE) settings play an important role in child dietary intake and excess weight gain. Policy, systems, and environment (PSE) approaches have potential to reduce disparities in children at higher risk for obesity. The purpose of this review was to (1) characterize the inclusion of populations at higher risk for obesity in ECE interventions and (2) identify effective ECE interventions in these populations. Seven databases were searched for ECE interventions. Intervention characteristics and methodological quality were assessed in 35 articles representing 34 interventions. Interventions identified were mainly a combination of ECE and parent interventions (41%) or stand-alone ECE intervention (29%), with few multisector efforts (23%) or government regulations assessed (5%). Many included policy (70%) or social environment components (61%). For Aim 1, two thirds were conducted in primarily populations at higher risk for obesity (67%). Studies were rated as fair or good methodological quality. For Aim 2, 10 studies demonstrated effectiveness at improving diet or reducing obesity in populations at higher risk for obesity. Most included a longer intervention (i.e., >6 months), multiple PSE components, and formative work. Opportunities to incorporate more PSE components in ECE-based interventions and collaborate with parents and communities are warranted to improve child health.
Collapse
Affiliation(s)
- Chelsea L. Kracht
- Clinical Science Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Emily W. Flanagan
- Clinical Science Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily Melnick
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Courtney Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
18
|
Redondo-Tebar A, Ruiz-Hermosa A, Martinez-Vizcaino V, Bermejo-Cantarero A, Cavero-Redondo I, Martín-Espinosa NM, Sanchez-Lopez M. Effectiveness of MOVI-KIDS programme on health-related quality of life in children: Cluster-randomized controlled trial. Scand J Med Sci Sports 2022; 33:660-669. [PMID: 36564974 DOI: 10.1111/sms.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To test the effectiveness of an 8-month school-based multicomponent intervention (MOVI-KIDS) in improving health-related quality of life (HRQoL) in schoolchildren. STUDY DESIGN A randomized cluster trial was conducted including 1168 children aged 4-6 years who attended 21 schools in two Spanish provinces (Cuenca and Ciudad Real). MOVI-KIDS study is a multicomponent physical activity intervention, which consisted of (i) 3 × 60-min sessions/week, (ii) educational materials for parents and teachers, and (iii) school playground modifications. The parent's proxy report of the KINDL-R Spanish version (6 subdimensions and a total score), and the KINDL-R self-reported by children (total score) was used to measure HRQoL. Mixed linear regression models were conducted to test differences in each HRQoL dimension between intervention and control groups, controlling for baseline values, cardiorespiratory fitness, and socioeconomic status, by gender. RESULTS The boys in the intervention group presented better scores on total HRQoL than the control group in both the parent (ß = 1.46; 95% CI: 0.23-2.70) and self-reported (ß = 2.13; 95% CI: 0.53-3.74) versions, as well as on the emotional well-being dimension (ß = 2.43; 95% CI: 0.48-4.36). There was no significant effect of the intervention on physical well-being, self-esteem, family, and friends. In girls, no statistically significant differences were found between those who participated in MOVI-KIDS and those who did not. CONCLUSION Our data support gender differences in the effect of MOVI-KIDS, such that while in boys the intervention was successful in increasing total scores of HRQoL, as well as emotional well-being scores, the intervention was not effective in improving girls' HRQoL.
Collapse
Affiliation(s)
- Andres Redondo-Tebar
- Universidad de Granada, PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Granada, Spain.,Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain
| | - Abel Ruiz-Hermosa
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain.,Universidad de Extremadura, ACAFYDE research group, Cáceres, Spain
| | - Vicente Martinez-Vizcaino
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Alberto Bermejo-Cantarero
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain.,Facultad de Enfermería, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.,Facultad de Enfermería, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | - Mairena Sanchez-Lopez
- Universidad de Castilla-La Mancha, Social and Health Research Center, Cuenca, Spain.,Facultad de Educación, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| |
Collapse
|
19
|
Draper CE, Klingberg S, Wrottesley SV, Milner K, Fisher J, Lakes KD, Yousafzai AK. Interventions to promote development in the next 1000 days: A mapping review. Child Care Health Dev 2022. [PMID: 36418186 DOI: 10.1111/cch.13084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
The next 1000 days - the period from 2 to 5 years of age - has been highlighted as a key developmental stage in the life-course. A mapping review was conducted to categorize existing literature on interventions in the next 1000 days that promote key developmental outcomes, including publications between 1990 and July 2020. A total of 805 intervention studies were included for data extraction in the review. The number of intervention studies has increased substantially from 2010. Most interventions were from high-income countries, with few (5%) from low- and lower-middle-income countries. Interventions including typically developing children (n = 593, 74%) were mostly (80%) implemented in early childhood care and education (ECCE) settings, with 15% taking place in the home or with families and 5% in community or healthcare settings. Children's literacy and language outcomes were the target of 27% of these interventions, while 25% of interventions targeted early childhood development more holistically or targeted multiple developmental domains. Social-emotional development and social skills were the target of 15% of interventions, motor development 13%, numeracy 8% and cognitive development 8%. For children with any developmental delay, disability, disease or exposure (n = 212), interventions frequently targeted Autism Spectrum Disorder (24%), language or literacy delays (21%), developmental delays or disability more generally (20%); 16% targeted behavioral (or conduct) problems; and 5% targeted attention deficit hyperactivity disorder. Almost half (49%) took place in ECCE settings; 24% occurred in the home or with families, or in community (13%) and/or healthcare (14%) settings. This review highlights the need for more intervention research in low- and middle-income countries and for interventions supporting development in the next 1000 days. While the evidence base for interventions to promote development in this age group continues to expand, the most vulnerable children are not benefiting from this evidence.
Collapse
Affiliation(s)
- Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Milner
- Neurodisability and Rehabilitation Research Group, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kimberley D Lakes
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
20
|
Jiang C, Cheng Y, Jiang S. Examining the mediator and moderator of the link between Migration-Related stress and depression amongst Chinese migrant children. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6044-e6055. [PMID: 36134943 DOI: 10.1111/hsc.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/05/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Migration-related stress is detrimental to children's mental health, yet little is known about the potential mechanisms behind this association. This study examines the mediating role of inflow city identity in the association between migration-related stress and depression and the moderating role of social participation amongst Chinese migrant children. A sample of 484 migrant children aged 8-17 years is randomly recruited through a cross-sectional survey in Kunming, China. Inflow city identity partially mediates the association between migration-related stress and migrant children's depression. Moreover, social participation moderates the above relationship. The direct and indirect effects are significant for migrant children with low social participation but insignificant for migrant children with high social participation. This study deepens the theoretical understanding of the underlying mechanism between migration stress and psychological distress and provides practical implications for preventing mental disorders in Chinese migrant children.
Collapse
Affiliation(s)
- Chaoxin Jiang
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Zhejiang, Hangzhou, China
| | - Yuhang Cheng
- Department of Sociology, Zhejiang University, Zhejiang, Hangzhou, China
| | - Shan Jiang
- Department of Sociology, Zhejiang University, Zhejiang, Hangzhou, China
| |
Collapse
|
21
|
Magee L, Goldsmith LP, Chaudhry UAR, Donin AS, Wahlich C, Stovold E, Nightingale CM, Rudnicka AR, Owen CG. Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:1084-1097. [PMID: 36094530 PMCID: PMC9468945 DOI: 10.1001/jamapediatrics.2022.3172] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Abstract
Importance Adequate sleep duration is necessary for many aspects of child health, development, and well-being, yet sleep durations for children are declining, and effective strategies to increase sleep in healthy children remain to be elucidated. Objective To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions. Data Sources CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021. Study Selection Randomized clinical trials of interventions to improve sleep duration in healthy children were independently screened by 2 researchers. A total of 28 478 studies were identified. Data Extraction and Synthesis Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Random-effects meta-analytic models were used to estimate pooled effect sizes. Main Outcomes and Measures Difference in sleep duration, measured in minutes. Results A total of 13 539 child participants from 45 randomized clinical trials were included. Of these, 6897 (50.9%) were in the intervention group and 6642 (49.1%) in the control group, and the mean age ranged from 18 months to 19 years. Pooled results indicate that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4) longer nocturnal sleep duration. There was substantial variation between trials. Sources of variation that were not associated with the study effect size included age group, whether the population was identified as having a sleep problem or being at a socioeconomic disadvantage (eg, coming from a low-income family or area), method of assessment of sleep duration (objective vs subjective), location of intervention delivery (home vs school), whether interventions were delivered in person or used parental involvement, whether behavioral theory was used, environmental change, or had greater or lower intensity. Interventions that included earlier bedtimes were associated with a 47-minute sleep extension (95% CI, 18.9-75.0; 3 trials) compared with remaining studies (7.4 minutes; 95% CI, 2.9-11.8; 42 trials) (P = .006 for group difference). Trials of shorter duration (6 months or less) had larger effects. Conclusions and Relevance Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.
Collapse
Affiliation(s)
- Lucia Magee
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Lucy P. Goldsmith
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Umar A. R. Chaudhry
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Angela S. Donin
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Charlotte Wahlich
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Elizabeth Stovold
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Claire M. Nightingale
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Alicja R. Rudnicka
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Christopher G. Owen
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| |
Collapse
|
22
|
Moss S, Gu X. Home- and Community-Based Interventions for Physical Activity and Early Child Development: A Systematic Review of Effective Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911968. [PMID: 36231271 PMCID: PMC9565703 DOI: 10.3390/ijerph191911968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 06/09/2023]
Abstract
This systematic review examined the effects of home/family and community-based interventions on physical activity (PA) and developmental outcomes in early childhood. A search strategy was employed using four electronic databases (Academic Search Complete, CINAHL Complete, MEDLINE, and SPORTDiscus). Interventions investigating weight status (i.e., BMI), physical activity, sedentary behavior, and/or motor proficiency that took place in home, family, or community settings were assessed. Studies were eligible if they were peer-reviewed, available in English, published between 2011 and 2021, and if samples consisted of healthy young children (2-5 years old). There were 24 studies retained (8351 participants) spanning from the United States (n = 12), Australia (n = 3), Canada (n = 2), Switzerland (n = 2), Finland (n = 2), Netherlands (n = 1), and other Eastern European countries (n = 2). There were 19 studies that incorporated home/family-based approaches and 14 studies that incorporated community-based approaches. Studies ranged in intervention duration from 6 weeks to 24 months. It suggests that improving PA participation in young children was especially challenging to solicit improvement (only 25% of all studies found significant improvement in PA after intervention). Distributing educational material to parents/families, consistent, direct contact with parents, and encouraging community engagement were identified as effective strategies to promote physical activity, healthy weight status, and motor skills in young children.
Collapse
Affiliation(s)
- Samantha Moss
- Department of Kinesiology, State University of New York at Cortland, Cortland, NY 13090, USA
| | - Xiangli Gu
- Department off Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA
| |
Collapse
|
23
|
Jylänki P, Mbay T, Byman A, Hakkarainen A, Sääkslahti A, Aunio P. Cognitive and Academic Outcomes of Fundamental Motor Skill and Physical Activity Interventions Designed for Children with Special Educational Needs: A Systematic Review. Brain Sci 2022; 12:brainsci12081001. [PMID: 36009064 PMCID: PMC9406044 DOI: 10.3390/brainsci12081001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
This systematic review aimed to investigate the methodological quality and the effects of fundamental motor skills and physical activity interventions on cognitive and academic skills in 3- to 7-year-old children with special educational needs. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. A literature search was carried out in April 2020 (updated in January 2022) using seven electronic databases, including ERIC, Scopus, Web of Science, PsycINFO, CINAHL, PubMed, and SPORTDiscus. The methodological quality of the studies was assessed with Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Cohen’s d effect sizes and post-hoc power analyses were conducted for the included studies. Altogether 22 studies (1883 children) met the inclusion criteria, representing children at-risk for learning difficulties, due to family background (nstudies = 8), children with learning difficulties (nstudies = 7), learning disabilities (nstudies = 5), and physical disabilities (nstudies = 2). Two of the included 22 studies displayed strong, one moderate, and 19 studies weak methodological quality. The intervention effects appeared to be somewhat dependent on the severity of the learning difficulty; in cognitive and language skills, the effects were largest in children at-risk due to family background, whereas in executive functions the effects were largest in children with learning disabilities. However, due to the vast heterogeneity of the included studies, and a rather low methodological quality, it is challenging to summarize the findings in a generalizable manner. Thus, additional high-quality research is required to determine the effectiveness of the interventions.
Collapse
Affiliation(s)
- Pinja Jylänki
- Faculty of Educational Sciences, University of Helsinki, 00170 Helsinki, Finland; (T.M.); (A.B.); (A.H.); (P.A.)
- Correspondence:
| | - Theo Mbay
- Faculty of Educational Sciences, University of Helsinki, 00170 Helsinki, Finland; (T.M.); (A.B.); (A.H.); (P.A.)
| | - Anni Byman
- Faculty of Educational Sciences, University of Helsinki, 00170 Helsinki, Finland; (T.M.); (A.B.); (A.H.); (P.A.)
| | - Airi Hakkarainen
- Faculty of Educational Sciences, University of Helsinki, 00170 Helsinki, Finland; (T.M.); (A.B.); (A.H.); (P.A.)
| | - Arja Sääkslahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40600 Jyväskylä, Finland;
| | - Pirjo Aunio
- Faculty of Educational Sciences, University of Helsinki, 00170 Helsinki, Finland; (T.M.); (A.B.); (A.H.); (P.A.)
| |
Collapse
|
24
|
Oh C, Carducci B, Vaivada T, Bhutta ZA. Interventions to Promote Physical Activity and Healthy Digital Media Use in Children and Adolescents: A Systematic Review. Pediatrics 2022; 149:186945. [PMID: 35503334 DOI: 10.1542/peds.2021-053852i] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify effective interventions that promote healthy screen time use and reduce sedentary behavior in school-age children and adolescents (SACA) in all settings, over the last 20 years. METHODS Searches were conducted from 2000 until March 2021 using PubMed, Embase, Medline, PsycINFO, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, and the WHO regional databases, including Google Scholar and reference lists of relevant articles and reviews. Randomized-controlled trials and quasi-experimental studies assessing interventions to reduce sedentary behaviors and screen time in healthy SACA (aged 5-19.9 years) globally. Data were extracted by 2 reviewers and where possible, pooled with a random-effects model. RESULTS The review included 51 studies, of which 23 were included in meta-analyses with 16 418 children and adolescents. Nondigital randomized-controlled trials reported a small, but significant reduction of TV-specific screen time (minutes per day) (mean difference, -12.46; 95% confidence interval, -20.82 to -4.10; moderate quality of evidence) and sedentary behavior (minutes per day) (mean difference, -3.86; 95% confidence interval, -6.30 to -1.41; participants = 8920; studies = 8; P = .002; moderate quality of evidence) as compared with control groups. For quasi-experimental studies, nondigital interventions may make little or no difference on screen time (minutes per day) or sedentary behavior (minutes per day), given the high uncertainty of evidence. Most studies were conducted in a high-income country. Generalizability of results to low- and middle- income countries remain limited. CONCLUSIONS Public health policies and programs will be necessary to reduce excessive sedentary behavior and screen time, especially in the post-coronavirus disease 2019 reality.
Collapse
Affiliation(s)
- Christina Oh
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Bianca Carducci
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
25
|
Collings PJ, Grøntved A, Jago R, Kriemler S, Northstone K, Puder JJ, Salmon J, Sardinha LB, Steene-Johannessen J, van Sluijs EMF, Sherar LB, Esliger DW, Ekelund U. Cross-sectional and prospective associations of sleep duration and bedtimes with adiposity and obesity risk in 15 810 youth from 11 international cohorts. Pediatr Obes 2022; 17:e12873. [PMID: 34851038 DOI: 10.1111/ijpo.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate associations of bedtimes and sleep durations with adiposity levels in children and adolescents. METHODS Individual data were pooled for 12 247 children (5819 with follow-up adiposity at 2.3 ± 1.4 years post-baseline) and 3563 adolescents from 11 international studies. Associations between questionnaire-based sleep durations, bedtimes and four groups of combined bedtimes and sleep lengths (later-shorter [reference]/earlier-shorter/later-longer/earlier-longer) with measured adiposity (body mass index [BMI] and waist circumference z-scores) and weight status, were investigated. RESULTS In children, longer sleep durations were consistently associated with lower adiposity markers, and earlier bedtimes were related to lower BMI z-score. Compared to sleeping <10 h, longer baseline sleep duration favourably predicted Δwaist z-score in girls (≥10 and <11 h (β-coefficient (95% confidence interval [CI])): -0.06 (-0.12 to -0.01)) and boys (≥11 h: -0.10 [-0.18 to -0.01]). Combined groups that were defined by longer sleep (later-longer and earlier-longer sleep patterns) were associated with lower adiposity, and later-longer sleep favourably predicted Δwaist z-score in girls (-0.09 [-0.15 to -0.02]). In adolescents, longer sleep durations and earlier bedtimes were associated with lower BMI z-score in the whole sample, and also with lower waist z-score in boys. Combined groups that were characterized by earlier bedtimes were associated with the same outcomes. For example, earlier-shorter (-0.22 (-0.43 to -0.01) and earlier-longer (-0.16 (-0.25 to -0.06) sleep were both associated with lower BMI z-score. CONCLUSIONS If the associations are causal, longer sleep duration and earlier bedtimes should be targeted for obesity prevention, emphasizing longer sleep for children and earlier bedtimes for adolescents.
Collapse
Affiliation(s)
- Paul J Collings
- Department of Health Sciences, University of York, York, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anders Grøntved
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jardena J Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | |
Collapse
|
26
|
Ke D, Maimaitijiang R, Shen S, Kishi H, Kurokawa Y, Suzuki K. Field-based physical fitness assessment in preschool children: A scoping review. Front Pediatr 2022; 10:939442. [PMID: 35989998 PMCID: PMC9387554 DOI: 10.3389/fped.2022.939442] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022] Open
Abstract
Physical fitness, which can be measured using various health- and skill-related components, is an important indicator of child development and health status. This study undertakes a scoping review on physical fitness assessment methods in preschool children to summarize the most widely used field-based physical fitness batteries and specific test items for preschool children. A search of the literature in English was undertaken using two major electronics databases, which yielded 76 literatures that met the inclusion and exclusion criteria. These literatures took the quantitative indicators of physical fitness as the outcome variables in 3-6-year-old children. This review found that of these 76 literatures analyzed, 71.1% came from Europe and 89.5% were published after 2010. The results showed six physical fitness test batteries, with the assessing FITness in PREschoolers (PREFIT) battery is the most widely used, and specific test items such as body mass index (BMI), standing long jump, handgrip, one-leg stance, sit and reach, 20 m shuttle run test (SRT)-PREFIT, and 4 × 10 m SRT are widely used in corresponding components. Therefore, we recommend that an international standard for some specific test items should be developed for preschool children to facilitate more widespread adoption and promote physical fitness assessment for preschool children.
Collapse
Affiliation(s)
- Dandan Ke
- School of Public Health, Fudan University, Shanghai, China.,Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | | | - Shaoshuai Shen
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan.,School of Education and Welfare, Aichi Prefectural University, Aichi, Japan
| | - Hidetada Kishi
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Yusuke Kurokawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Koya Suzuki
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| |
Collapse
|
27
|
The effect of a multidisciplinary lifestyle modification program for obese and overweight children. J Formos Med Assoc 2022; 121:1773-1785. [DOI: 10.1016/j.jfma.2022.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
|
28
|
St Laurent CW, Rodheim K, Spencer RMC. A Systematic Review of the Relationships Between Physical Activity and Sleep in Early Childhood. KINESIOLOGY REVIEW (CHAMPAIGN, ILL.) 2021; 11:121-137. [PMID: 35873529 PMCID: PMC9302480 DOI: 10.1123/kr.2020-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this systematic review was to examine the associations between physical activity and sleep in children aged less than 6 years. Articles were included if participants were primarily aged less than 6 years and study designs were observational or experimental. Study characteristics were extracted, and the Grading Recommendations Assessment, Development and Evaluation framework was used to assess study quality. Thirty-six studies (16 sleep, 16 physical activity, and three fitness outcomes) from 18 countries reported in 29 articles were included. The majority of sleep and physical activity outcome studies reported mixed effects with very low to low quality of evidence. Fitness outcome studies were limited, and therefore, evidence was insufficient. The high prevalence of mixed and null results could be related to study limitations. Importantly, this review points to the critical need for higher quality studies of sleep and physical activity in young children, which would support health recommendations and intervention strategies for healthier child development.
Collapse
Affiliation(s)
- Christine W St Laurent
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Katrina Rodheim
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rebecca M C Spencer
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Institute of Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| |
Collapse
|
29
|
Protocol for a quasi-experimental study examining the effect of a ball skills intervention on four domains of preschooler development. Prim Health Care Res Dev 2021; 22:e69. [PMID: 34753530 PMCID: PMC8581457 DOI: 10.1017/s1463423621000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Preschooler inactivity and insufficient motor development have serious long-term consequences. The Chinese Ministry of Education launched a nationwide football-focused pilot project aimed at kindergartens in 2019 and issued the policy “Notice on the Establishment of National Football Kindergartens” in 2020. However, the impact of fundamental movement skills (FMS) interventions on other aspects of child development is unclear. Aim: This study will evaluate the effects of ball skills physical education projects on the development of Chinese preschoolers’ physical, motor, cognitive, and social competencies and examine the influencing factors. Method: This is a quasi-experimental study evaluating how well the “Hello Sunshine” curriculum project promotes children’s development over 10 weeks. The trial will be conducted from September 2021 to November 2021 in 12 classes from 3 kindergartens with a total of 249 children aged 4 to 6 years in Haikou, China. Pre- and posttest analyses will include tests on participants’ physical fitness, FMS, cognitive self-regulation, and emotional competence. Participants’ background information will be collected through questionnaires answered by parents and teachers. The intervention will focus on game-based basic ball skills. Findings: If this intervention provides evidence that these skills improve children’s multidimensional development, it will support the promotion of similar programs in China. We will also outline the social-ecological factors affecting the intervention’s results, providing further information for improving pedagogical methods related to preschool ball skills.
Collapse
|
30
|
Sports, Executive Functions and Academic Performance: A Comparison between Martial Arts, Team Sports, and Sedentary Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211745. [PMID: 34831501 PMCID: PMC8622860 DOI: 10.3390/ijerph182211745] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
It is well known that curricular physical activity benefits children’s executive functions and academic performance. Therefore, this study aimed to determine whether there is an influence of extracurricular sports on executive functions and academic performance. However, it is less known which specific types of the sport better enhance executive functions in children; to investigate this issue, this study compared the performance on executive functions tasks and academic performance in one hundred and two boys and girls with an average age of 11.84 years recruited from Italian schools and gyms (N = 102), who participated in martial arts or team sports or were sedentary children. Executive functions were measured with the tests: Attenzione e Concentrazione, Digit Span test, Tower of London, IOWA Gambling task BVN 5-11, and BVN 12-18. Results demonstrated that children practicing martial arts showed better executive functioning and higher school marks than those involved in team sports or not involved in any sports. Furthermore, participants aged 12 to 15 years old outperformed in cool and hot executive functions tasks and had a better academic performance. Thus, the present findings supported the view that regular practice of extracurricular sports enhances executive functions development and consequently influences academic performance.
Collapse
|
31
|
Akçay D, Barış N. Evaluating the effectiveness of interventions to reducing screen time in children: meta-analysis of randomized controlled trials. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-03-2021-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to evaluate the impact of interventions focused on reducing screen time in children.
Design/methodology/approach
Studies that aim to investigate the effects of interventions aimed at reducing the time spent in front of the screen (i.e. screen time). A Random-effects model was used to calculate the pooled standard mean differences. The outcome was to evaluate the screen time in children in the 0–18 age range. A subgroup analysis was performed to reveal the extent to which the overall effect size varied by subgroups (participant age, duration of intervention and follow).
Findings
For the outcome, the meta-analysis included 21 studies, and the standard difference in mean change in screen time in the intervention group compared with the control group was −0.16 (95% confidence interval [CI], −0.21 to −0.12) (p < 0.001). The effect size was found to be higher in long-term (=7 months) interventions and follow-ups (p < 0.05).
Originality/value
Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention and follow-up was =7 months. As the evidence base grows, future researchers can contribute to these findings by conducting a more comprehensive analysis of effect modifiers and optimizing interventions to reduce screen time.
Collapse
|
32
|
Arnaiz P, Adams L, Müller I, Gerber M, Walter C, du Randt R, Steinmann P, Bergman MM, Seelig H, van Greunen D, Utzinger J, Pühse U. Sustainability of a school-based health intervention for prevention of non-communicable diseases in marginalised communities: protocol for a mixed-methods cohort study. BMJ Open 2021; 11:e047296. [PMID: 34610931 PMCID: PMC8493924 DOI: 10.1136/bmjopen-2020-047296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The prevalence of chronic, lifestyle-related diseases is increasing among adults and children from low-income and middle-income countries. Despite the effectiveness of community-based interventions to address this situation, the benefits thereof may disappear in the long term, due to a lack of maintenance, especially among disadvantaged and high-risk populations. The KaziBantu randomised controlled trial conducted in 2019 consisted of two school-based health interventions, KaziKidz and KaziHealth. This study will evaluate the long-term effectiveness and sustainability of these interventions in promoting positive lifestyle changes among children and educators in disadvantaged schools in Nelson Mandela Bay, South Africa, in the context of the COVID-19 pandemic. METHODS AND ANALYSIS This study has an observational, longitudinal, mixed-methods design. It will follow up educators and children from the KaziBantu study. All 160 educators enrolled in KaziHealth will be invited to participate, while the study will focus on 361 KaziKidz children (aged 10-16 years) identified as having an increased risk for non-communicable diseases. Data collection will take place 1.5 and 2 years postintervention and includes quantitative and qualitative methods, such as anthropometric measurements, clinical assessments, questionnaires, interviews and focus group discussions. Analyses will encompass: prevalence of health parameters; descriptive frequencies of self-reported health behaviours and quality of life; the longitudinal association of these; extent of implementation; personal experiences with the programmes and an impact analysis based on the Reach, Efficacy, Adoption, Implementation, Maintenance framework. DISCUSSION In settings where resources are scarce, sustainable and effective prevention programmes are needed. The purpose of this protocol is to outline the design of a study to evaluate KaziKidz and KaziHealth under real-world conditions in terms of effectiveness, being long-lasting and becoming institutionalised. We hypothesise that a mixed-methods approach will increase understanding of the interventions' capacity to lead to sustainable favourable health outcomes amid challenging environments, thereby generating evidence for policy. TRIAL REGISTRATION NUMBER ISRCTN15648510.
Collapse
Affiliation(s)
- Patricia Arnaiz
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Darelle van Greunen
- Centre for Community Technologies, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| |
Collapse
|
33
|
Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
Collapse
Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| |
Collapse
|
34
|
Physical Activity, Fitness, School Readiness, and Cognition in Early Childhood: A Systematic Review. J Phys Act Health 2021; 18:1004-1013. [PMID: 34140418 DOI: 10.1123/jpah.2020-0844] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early childhood is an important age for brain and cognitive development. Given the support of physical activity and fitness on cognition and academic performance in older children, more research has emerged recently focusing on younger children. In this systematic review, the authors review the relations between physical activity/fitness and academic-related (ie, school readiness and cognitive) outcomes in early childhood. METHODS A search was conducted from PubMed, PsycINFO, Web of Science, ERIC databases, and reference lists for articles that had participants aged less than 6 years were written in English, and were in peer-reviewed journals. Articles were excluded if the design was a case study or case series report. The Grading Recommendations Assessment, Development and Evaluation framework was followed to assess the quality of evidence by study design. RESULTS Sixty-eight articles reporting on 72 studies (29 observational and 43 experimental) were included. The majority of study effects were mixed, and the quality of evidence varied from very low to low. CONCLUSIONS A clear consensus about the role of physical activity and fitness on academic-related outcomes in early childhood is still lacking given the high heterogeneity in methodological approaches and overall effects. Additional high-quality studies are needed to determine what specific dosages of physical activity are impactful at this age.
Collapse
|
35
|
Truong K, Park S, Tsiros MD, Milne N. Physiotherapy and related management for childhood obesity: A systematic scoping review. PLoS One 2021; 16:e0252572. [PMID: 34125850 PMCID: PMC8202913 DOI: 10.1371/journal.pone.0252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Kim Truong
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Sandra Park
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Margarita D. Tsiros
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| |
Collapse
|
36
|
Long Q, Zhang T, Chen F, Wang W, Chen X, Ma M. Effectiveness of dietary interventions on weight outcomes in childhood: a systematic review meta-analysis of randomized controlled trials. Transl Pediatr 2021; 10:701-714. [PMID: 34012820 PMCID: PMC8107859 DOI: 10.21037/tp-20-183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rapid growth and elevated weight in childhood are significantly associated with obesity in later life, but evidence regarding dietary interventions and weight outcomes is lacking. This study aimed to determine the effectiveness of dietary interventions on body mass index (BMI) and BMI z-score in childhood. METHODS PubMed, EmBase, and the Cochrane library were searched from inception till June 2019. Studies that investigated the effectiveness of dietary interventions on BMI and BMI z-score in childhood were considered eligible in our study. The changes in BMI and BMI z-score between dietary interventions and control were calculated by pooled weighted mean differences (WMDs) and 95% CIs were evaluated using random-effects model. RESULTS Twenty-eight randomized controlled trials involving a total of 17,488 children were included. The summary WMDs indicated that children who received dietary interventions had greater reduction in BMI (WMD: -0.12; 95% CI: -0.20 to -0.05; P=0.001) and BMI z-score (WMD: -0.04; 95% CI: -0.06 to -0.02; P=0.001) when compared to the usual controls. Subgroup analyses revealed that the sample size, mean age, duration of interventions, and study quality could affect the effectiveness of dietary interventions in children. CONCLUSIONS The findings of this meta-analysis suggested that dietary interventions improved BMI and BMI z-score, whereas these results are limited due to substantial heterogeneity and study quality of the included studies.
Collapse
Affiliation(s)
- Qi Long
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ting Zhang
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Chen
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wenqiao Wang
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xia Chen
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ming Ma
- Department of Clinical Nutrition, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
37
|
Higher cardiorespiratory fitness is strongly associated with lower cardiovascular risk factors in firefighters: a cross-sectional study in a German fire brigade. Sci Rep 2021; 11:2445. [PMID: 33510237 PMCID: PMC7843993 DOI: 10.1038/s41598-021-81921-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023] Open
Abstract
Previous studies have shown significant cardiovascular risks in firefighters and that they suffer from cardiovascular events, especially on duty. Otherwise, adequate cardiorespiratory fitness is considered to have a protective effect in reducing cardiovascular complications. Therefore, the study aimed to evaluate the association between cardiorespiratory fitness and cardiovascular risks factors in firefighters. We enrolled ninety-seven male German firefighters in this cross-sectional study of cardiorespiratory fitness and cardiovascular risk factors. We used spiroergometry testing to estimate oxygen consumption to determine cardiorespiratory fitness and to calculate metabolic equivalents. We evaluated cardiovascular risk factors included nicotine consumption, lipid profiles, body composition, resting blood pressure, and heart rate. We evaluated cardiovascular risk factors included nicotine consumption, lipid profiles, body composition, resting blood pressure and heart rate. The comparison of association between cardiorespiratory fitness and cardiovascular risk factors was performed by using χ2-test, analysis of variance, general linear regression with/without adjustment for age and body mass index (BMI). This study demonstrated a strong association between lower cardiovascular risk factors and higher cardiorespiratory fitness. There were significantly lower values for BMI, waist circumference, body fat percentage and resting systolic blood pressure, triglycerides, and total cholesterol (all p < 0.0443, age-adjusted) with increased cardiorespiratory fitness. Only 19.6% (n = 19) of the examined firefighters were classified as “fit and not obese”, 48.4% (n = 47) were “low fit and not obese” and 30.9% (n = 30) were “low fit and obese”. The results clarify that increasing cardiorespiratory fitness is a fundamental point for the reduction and prevention of cardiovascular complications in firefighters. It could be demonstrated, especially for central risk factors, particularly BMI, waist circumference, sytolic resting blood pressure and triglyceride values. Therefore, firefighters should be motivated to increase their cardiorespiratory fitness for the beneficial effect of decreasing cardiovascular risk profile.
Collapse
|
38
|
Hartwig TB, Sanders T, Vasconcellos D, Noetel M, Parker PD, Lubans DR, Andrade S, Ávila-García M, Bartholomew J, Belton S, Brooks NE, Bugge A, Cavero-Redondo I, Christiansen LB, Cohen K, Coppinger T, Dyrstad S, Errisuriz V, Fairclough S, Gorely T, Javier Huertas-Delgado F, Issartel J, Kriemler S, Kvalø SE, Marques-Vidal P, Martinez-Vizcaino V, Møller NC, Moran C, Morris J, Nevill M, Ochoa-Avilés A, O'Leary M, Peralta L, Pfeiffer KA, Puder J, Redondo-Tébar A, Robbins LB, Sanchez-Lopez M, Tarp J, Taylor S, Tercedor P, Toftager M, Villa-González E, Wedderkopp N, Weston KL, Yin Z, Zhixiong Z, Lonsdale C, Del Pozo Cruz B. School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials. Br J Sports Med 2021; 55:bjsports-2020-102740. [PMID: 33441332 DOI: 10.1136/bjsports-2020-102740] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.
Collapse
Affiliation(s)
- Timothy Bryan Hartwig
- School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, New South Wales, Australia
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia
| | - Diego Vasconcellos
- Institute for Positive Psychology and Education, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia
| | - Michael Noetel
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Philip D Parker
- Institute for Positive Psychology and Education, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia
| | - David Revalds Lubans
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia
| | - Susana Andrade
- Faculty of Philosophy, Letters and Education Sciences, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Manuel Ávila-García
- Department of Physical Education and Sports, University of Granada, Granada, Andalucía, Spain
| | - John Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Sarahjane Belton
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Naomi E Brooks
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Stirling, UK
| | - Anna Bugge
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy Faculty of Health, University of Copenhagen, Kobenhavn, Denmark
| | - Iván Cavero-Redondo
- Social and Health Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Lars Breum Christiansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristen Cohen
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle Faculty of Science, Callaghan, New South Wales, Australia
| | - Tara Coppinger
- Department of Sport, Leisure and Childhood Studies, Cork Institute of Technology, Cork, Cork, Ireland
| | - Sindre Dyrstad
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Vanessa Errisuriz
- Latino Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Stuart Fairclough
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, UK
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands Inverness College, Inverness, Highland, UK
| | | | - Johann Issartel
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, ZH, Switzerland
| | | | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Niels Christian Møller
- Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Colin Moran
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Stirling, UK
| | - John Morris
- Department of Sport Science, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Mary Nevill
- Department of Sport Science, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Angélica Ochoa-Avilés
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Mai O'Leary
- Department of Sport, Leisure and Childhood Studies, Cork Institute of Technology, Cork, Cork, Ireland
| | - Louisa Peralta
- Sydney School of Education and Social Work, University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia
| | - Karin A Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jardena Puder
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrés Redondo-Tébar
- Health and Social Research Center, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Lorraine B Robbins
- Nursing Education and Research, Michigan State University, East Lansing, Michigan, USA
| | - Mairena Sanchez-Lopez
- Social and Health Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jakob Tarp
- Department of Sports Medicine, Norwegian School ofSports Sciences, Oslo, Norway
| | - Sarah Taylor
- Physical Activity Exchange, Research Institute for Sport andExercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Pablo Tercedor
- Department of Physical Education and Sports, University of Granada, Granada, Andalucía, Spain
| | - Mette Toftager
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Emilio Villa-González
- Department of Physical Education and Sports, University of Granada, Granada, Andalucía, Spain
| | - Niels Wedderkopp
- Orthopedic Department, Hospital Of Southwestern Jutland, Esbjerg, Denmark
| | - Kathryn Louise Weston
- School of Applied Sciences Sighthill Campus, Edinburgh Napier University, Edinburgh, UK
| | - Zenong Yin
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Zhou Zhixiong
- Institute for Sport Performance and Health Promotion, Capital University of Sports and Physical Education, Beijing, China
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia
| | - Borja Del Pozo Cruz
- Institute for Positive Psychology and Education, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia
| |
Collapse
|
39
|
Mazurak N, Cook J, Weiland A, Ritze Y, Urschitz M, Junne F, Zipfel S, Enck P, Mack I. Impact of Childhood Obesity and Psychological Factors on Sleep. Front Psychiatry 2021; 12:657322. [PMID: 34305673 PMCID: PMC8298750 DOI: 10.3389/fpsyt.2021.657322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to analyze sleep duration and behaviors in relation to psychological parameters in children and adolescents with obesity seeking inpatient weight-loss treatment in comparison to normal-weight children, and whether or not these variables would improve during the time course of treatment. Sixty children or adolescents with overweight and obesity (OBE) and 27 normal-weight (NW) peers (age: 9-17) were assessed for subjective sleep measures through self-reported and parent-reported questionnaires, as well as body weight, body composition, and psychological questionnaires. The OBE participants were assessed upon admission and before discharge of an inpatient multidisciplinary weight-loss program. NW participants' data were collected for cross-sectional comparison. In comparison to NW, children and adolescents with OBE had a shorter self-reported sleep duration and had poorer sleep behaviors and more sleep-disordered breathing as reported by their parents. No change in sleep measures occurred during the inpatient treatment. Psychological factors including higher anxiety, depression, and destructive-anger-related emotion regulation were moderate predictors for unfavorable sleep outcomes, independent of weight status. Children with obesity had less favorable sleep patterns, and psychological factors influenced sleep in children, independent of weight. More research is needed on the relationship and direction of influence between sleep, psychological factors, and obesity, and whether they can be integrated in the prevention and management of childhood obesity and possibly also other pediatric diseases.
Collapse
Affiliation(s)
- Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Jessica Cook
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Yvonne Ritze
- Institute of Medical Psychology and Behavioral Neurobiology, University Hospital, Tübingen, Germany
| | - Michael Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| |
Collapse
|
40
|
Sanchez-Flack JC, Herman A, Buscemi J, Kong A, Bains A, Fitzgibbon ML. A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework. Transl Behav Med 2020; 10:1168-1176. [PMID: 33044537 PMCID: PMC7549410 DOI: 10.1093/tbm/ibz179] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.
Collapse
Affiliation(s)
| | - Annie Herman
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexis Bains
- Department of Kinesiology and Nutrition, College of Applied Health, Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian L Fitzgibbon
- Department of Pediatrics and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
41
|
García-Hermoso A, Alonso-Martinez AM, Ramírez-Vélez R, Izquierdo M. Effects of Exercise Intervention on Health-Related Physical Fitness and Blood Pressure in Preschool Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 2020; 50:187-203. [PMID: 31556009 DOI: 10.1007/s40279-019-01191-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND No previous systematic review has quantitatively examined the effect of physical exercise interventions on health-related physical fitness and blood pressure in children younger than 6 years old. OBJECTIVE To evaluate the effects of exercise interventions on health-related physical fitness (i.e., physical fitness components and body composition) and blood pressure in preschoolers. METHODS We searched four databases. Only randomized controlled trials (RCTs), evaluating the effectiveness of exercise intervention on weight-related outcomes, blood pressure, and physical fitness components in preschoolers (1-5.99 years old) were included. The effect sizes were reported as Hedges' g using random-effects models. RESULTS A total of 19 RCTs were included. Exercise interventions favored reductions in body mass index (g = - 0.17; 95% confidence interval [CI], - 0.31 to - 0.03), waist circumference (g = - 0.25; 95% CI - 0.47 to - 0.03), and body fat percentage (g = - 0.31; 95% CI - 0.60 to - 0.23); as well as improvement in cardiorespiratory fitness (g = 0.25; 95% CI 0.08-0.42), muscular strength (g = 0.25; 95% CI 0.09-0.40), and speed-agility (g = - 0.51; 95% CI - 0.78 to - 0.24). Blood pressure was not reduced. The subgroup analysis revealed that physical exercise alone favored larger reductions in body mass index and waist circumference compared with physical exercise combined with another intervention. Also, changes in cardiorespiratory fitness, lower-body muscular strength and speed-agility were associated with larger decreases in body composition. CONCLUSION Physical exercise whether combined or not with additional intervention has a small effect on both body weight and physical fitness in preschoolers. Also, it seems that interventions to prevent obesity should be directed towards improving physical fitness of preschoolers.
Collapse
Affiliation(s)
- Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain.
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile.
| | - Alicia M Alonso-Martinez
- Department of Health Sciences, Public University of Navarra, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
- Department of Health Sciences, Public University of Navarra, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
- Department of Health Sciences, Public University of Navarra, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
| |
Collapse
|
42
|
Mattson RE, Burns RD, Brusseau TA, Metos JM, Jordan KC. Comprehensive School Physical Activity Programming and Health Behavior Knowledge. Front Public Health 2020; 8:321. [PMID: 32793538 PMCID: PMC7393515 DOI: 10.3389/fpubh.2020.00321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
No study to date has examined the effect of a multicomponent school-based physical activity program on health behavior knowledge in a large sample of low-income children from the US. The purpose of this study was to explore the change in physical activity and nutrition knowledge during a Comprehensive School Physical Activity Program (CSPAP) in children. Participants were a convenience sample of 789 children recruited from the 4th to 6th grades from five low-income Title I schools located within the Mountain West Region of the US. Students completed two questionnaires consisting of a physical activity and a nutrition knowledge assessment. Questionnaires were administered at baseline before the commencement of CSPAP and at a 36-week follow-up. Data were analyzed using a 3 × 2 × 2 doubly MANOVA test. Physical activity knowledge scores significantly improved from pretest to posttest during the intervention (p = 0.045, Cohen's d = 0.18). Grade level modified the time effects, with older children in grades 5 and 6 displaying greater improvements in physical activity knowledge than younger children in grade 4 (p = 0.044, Cohen's d = 0.33). There were no significant improvements in nutrition knowledge scores during the CSPAP (p = 0.150). These findings demonstrate that improvements in physical activity knowledge can occur during a multicomponent school-based intervention. Improvements in physical activity knowledge may translate to improvements in habitual physical activity behaviors and positively influence children's health outcomes, especially in older children.
Collapse
Affiliation(s)
- Rose E Mattson
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Ryan D Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Timothy A Brusseau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Julie M Metos
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Kristine C Jordan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
43
|
Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
Collapse
Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| |
Collapse
|
44
|
Kobel S, Henle L, Laemmle C, Wartha O, Szagun B, Steinacker JM. Intervention Effects of a Kindergarten-Based Health Promotion Programme on Motor Abilities in Early Childhood. Front Public Health 2020; 8:219. [PMID: 32695738 PMCID: PMC7339446 DOI: 10.3389/fpubh.2020.00219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Physical activity is positively related to motor abilities. Especially in childhood, an active lifestyle is important to support healthy motor development. The low-threshold health promotion programme "Join the Healthy Boat" in kindergartens promotes physical activity in order to also improve motor abilities. Here, effects of the programme on children's motor abilities after 1 year were investigated. Materials and Methods: The longitudinal study included 419 children (3.7 ± 0.6 years) from 58 kindergartens throughout south-west Germany (intervention: 254, control: 165). Children in the intervention group received physical activity promotion with a focus on motor ability development, led by teachers, through one kindergarten year; children in the control group followed the normal kindergarten routine. At baseline and follow-up, motor tests (3-min-run, one-leg-stand, standing long jump, sit-and-reach-test) were performed, anthropometric measures (body weight and height) were taken and a parental questionnaire was issued. Intervention effects were assessed using differential measures (follow-up - baseline) adjusted for gender, age, socioeconomic status (SES) and baseline values, with covariance analyses. Results: Children in the intervention group showed a significant improvement in endurance performance ( F ( 1 . 329 ) = 20 . 95 , p < 0 . 000 , η P 2 = 0 . 060 ) , which applies to boys ( F ( 1 , 172 ) = 13 , 66 , p ≤ 0 . 000 , η P 2 = 0 , 074 ) and girls ( F ( 1 , 152 ) = 7 , 48 , p ≤ 0 . 007 , η P 2 = 0 , 047 ) . No significant intervention effects on endurance performance were found for children with low baseline values, children with a low SES, and children aged 5 years, nor for any other assessed motor ability. Conclusions: The theory-based, teacher-centered intervention promoting physical activity in order to also improve motor abilities has shown a positive effect on endurance performance in kindergarten children, but no other motor ability. Future interventions should therefore be either longer, more intense and take into account children's age, initial level of performance and their SES. In addition, the influence of teachers should be considered more closely in future research.
Collapse
Affiliation(s)
- Susanne Kobel
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Lea Henle
- Faculty Social Work, Health & Nursing, University of Applied Sciences Ravensburg-Weingarten, Weingarten, Germany
| | - Christine Laemmle
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Bertram Szagun
- Faculty Social Work, Health & Nursing, University of Applied Sciences Ravensburg-Weingarten, Weingarten, Germany
| | - Juergen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
45
|
Martin KB, Bednarz JM, Aromataris EC. Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis. J Sleep Res 2020; 30:e13130. [PMID: 32567219 DOI: 10.1111/jsr.13130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
Prolonged viewing of screen-based media is associated with poor sleep in children. Previous systematic reviews have analysed the effectiveness of interventions that aim to limit children's screen use; however, none have evaluated its effect on sleep. The aim of this systematic review was to evaluate the effect of interventions that incorporate strategies to control children's screen use on screen use and sleep. The databases Pubmed, Embase, Eric, Scopus and PsycInfo were searched during October 2017 and updated in February 2019 for experimental studies with a control that assessed interventions to control screen use in children aged 2-14 years and reported both screen use and sleep outcomes. From 3,872 initial records, 11 studies (six randomized control [RCT], four cluster RCT and one cluster, quasi-experimental) were eligible for inclusion. A total of 4,656 children aged 2-13 years were included in the studies. The mean reduction in screen time was 0.56 hr (33 min)/day (95% confidence interval [CI], 0.92, 0.20) and the mean sleep duration increased by 0.19 hr (11 min)/day (95% CI, 0.05, 0.33). Bedtime was advanced by 0.16 hr (10 min) on weekdays and by 1.0 hr at the weekend. Subgroup analyses indicated stronger intervention effects for interventions of shorter duration (<3 months), which specifically targeted screen use or sleep, and those with direct participant contact. In conclusion, small improvements in screen time and sleep duration can be achieved in children. It is not possible to determine if a reduction in screen time directly improves sleep, due to the limited number of studies, the presence of co-interventions, issues with studies' methodological quality and heterogeneity.
Collapse
Affiliation(s)
- Katie B Martin
- Joanna Briggs Institute, University of Adelaide, Adelaide, SA, Australia
| | - Jana M Bednarz
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | | |
Collapse
|
46
|
Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| |
Collapse
|
47
|
Dauben L, Weber KS, Nießen L, Verket M, Spörkel O, Strassburger K, Roden M, Kronsbein P, Müssig K. Associations Between Migration Background and Media and Information Behavior in Primary School Children. Exp Clin Endocrinol Diabetes 2020; 129:813-820. [PMID: 32164030 DOI: 10.1055/a-1114-5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with migration background and from low socio-economic status are at higher risk for overweight. To determine appropriate media channels to possibly reach children with targeted health information, it has to be considered that the media and information behavior of children has changed during the last decades. OBJECTIVE We examined the media and information behavior of children in low socio-economic districts, focusing on those with migration background. METHODS Fourteen 3rd grade classes (n=250 children, 68.0% with migration background) completed a questionnaire regarding their media consumption, which was based on existing validated surveys. RESULTS ≥ 50% of the children watched TV and around 40% used both mobile phones and computers/tablets/internet for ≥1 h/day. Books were the most popular analogue media (61.6% of children), whereas magazines/newspapers and radio (18.4 and 16.0% of children, respectively) were used less frequently. Furthermore, they regularly used internet, TV and their teachers (63.0, 48.8 and 44.8% of children, respectively) as information source. Especially children with compared to those without migration background less likely used the radio (P=0.0002) and their family as information source (P=0.0017). CONCLUSIONS Children attending 3rd grade class, especially with migration background, can be addressed through digital media rather than the radio. This may help to sustainably support children outside school with targeted health information.
Collapse
Affiliation(s)
- Laura Dauben
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Katharina S Weber
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Lisa Nießen
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Faculty of Food, Nutrition and Hospitality Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany
| | - Marlo Verket
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Olaf Spörkel
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter Kronsbein
- Faculty of Food, Nutrition and Hospitality Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Internal Medicine, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| |
Collapse
|
48
|
van de Kolk I, Gerards SMPL, Harms LSE, Kremers SPJ, Gubbels JS. The Effects of a Comprehensive, Integrated Obesity Prevention Intervention Approach (SuperFIT) on Children's Physical Activity, Sedentary Behavior, and BMI Z-Score. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5016. [PMID: 31835477 PMCID: PMC6950277 DOI: 10.3390/ijerph16245016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 01/28/2023]
Abstract
SuperFIT is a comprehensive, integrated intervention approach aimed at promoting healthy energy balance-related behaviors in 2- to 4-year-old children in the preschool and home settings. A quasi-experimental research design was adopted to evaluate the effects of SuperFIT on physical activity (PA), sedentary behavior (SB) and Body Mass Index (BMI) z-score. Children could participate in the preschool-based and family-based component (full intervention) or only in the preschool-based component (partial intervention). Children's PA levels and SB were assessed with accelerometers and observations, and height and weight were measured for the BMI z-score. Measurements were performed at baseline and two follow-up time points. Effectiveness was evaluated using linear mixed-model analyses, correcting for relevant covariates. Healthy changes in PA levels occurred within all study groups over time. No significant differences were found in overall PA levels between the intervention groups and control group at both follow-ups. Nevertheless, sedentary behavior decreased more in the full intervention group (effect size (ES): -0.62), and moderate-to-vigorous PA (ES: 0.85) and counts per minute (ES: 0.45) increased more compared to the control group on preschool days at the first follow-up. No effects were found for BMI z-score. The integrated approach of SuperFIT may induce changes in PA of young children, although the effects were small.
Collapse
Affiliation(s)
- Ilona van de Kolk
- Department of Health Promotion, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (S.M.P.L.G.); (L.S.E.H.); (S.P.J.K.); (J.S.G.)
| | | | | | | | | |
Collapse
|
49
|
Childcare Physical Activity Interventions: A Discussion of Similarities and Differences and Trends, Issues, and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234836. [PMID: 31810156 PMCID: PMC6926705 DOI: 10.3390/ijerph16234836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
Early childhood education and care (ECEC) settings have a pivotal role in the promotion of physical activity for young children, and thus, the number of ECEC-based physical activity interventions has exponentially increased in the last two decades. The aim of this study was three-fold: (1) to discuss some of the similarities and differences in ECEC-based physical activity interventions, (2) to highlight current trends and issues in the ECEC sector relating to such interventions, and (3) to provide recommendations for future interventions. Twenty-four individual studies are discussed. Most studies have targeted children aged between 3 and 5 years and involved children participating in additional physical activity opportunities while at childcare. In all studies, educators participated in some professional development either prior or during the intervention. Less the half of the studies discussed reported significant positive changes in physical activity outcomes. Those involved in developing future interventions will need to consider current national and international trends in the ECEC sector (e.g., over-crowded curriculum, administrative requirements, and more highly-qualified educators devoting time for business development), as well as creative and unique ways of delivering ECEC-based physical activity interventions.
Collapse
|
50
|
Venturelli F, Ferrari F, Broccoli S, Bonvicini L, Mancuso P, Bargellini A, Giorgi Rossi P. The effect of Public Health/Pediatric Obesity interventions on socioeconomic inequalities in childhood obesity: A scoping review. Obes Rev 2019; 20:1720-1739. [PMID: 31468647 PMCID: PMC6899709 DOI: 10.1111/obr.12931] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 01/16/2023]
Abstract
Childhood obesity has a strong social gradient. This scoping review aims to synthesize the evidence on the impact on inequalities of non-targeted interventions to reduce the prevalence of childhood and adolescent obesity in high-income countries. We updated a review by Hillier-Brown, searching up to 31 December 2017 on MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO, with no limitations on study design. Fifty-eight studies describing 51 interventions were included: 31 randomized clinical trials and 27 non-randomized trials, with sample sizes from 67 to 2,700,880 subjects. The majority were implemented in the school setting at a community level; the others were in health services or general population setting and targeting individuals or the system. Twenty-nine interventions proved to be effective overall; seven others had an effect only in a subgroup, while 15 proved not to be effective. All types of included interventions can increase inequalities. Moreover, some interventions had opposite effects based on the socioeconomic characteristics. Any kind of intervention can reduce equity. Consequences are difficult to predict based on intervention construct. Complex interventions acting on multiple targets, settings, and risk factors are more effective and have a lower risk of increasing inequalities.
Collapse
Affiliation(s)
- Francesco Venturelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Ferrari
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Bargellini
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|