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Pedersen NH, Grøntved A, Møller NC, Debrabant B, Larsen KT, Brønd JC, Troelsen J, Brage S, Hjelmborg JVB, Wedderkopp N, Christiansen LB, Mortensen SR, Egebæk HK, Toftager M, Heidemann MS, Kristensen PL. Impact of a nationwide school policy on body mass index in Danish school children: An interrupted time series analysis. PUBLIC HEALTH IN PRACTICE 2024; 7:100510. [PMID: 38826636 PMCID: PMC11141446 DOI: 10.1016/j.puhip.2024.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives A new school policy mandating 45 min physical activity daily during school was introduced in Denmark in 2014. We aimed to evaluate the effect of this policy on BMI in school-aged children. It was hypothesized that the school policy would decrease BMI, especially in the obese fraction of the population (90th percentile BMI). Study design This register-based study was conducted as a natural experiment. Methods Analyses were based on data from The National Child Health Register that contains nationwide data on height and weight from mandatory preventive health examinations completed by school nurses or medical doctors during pre-preparatory classes (0th-3rd grade) and lower secondary education (7th-9th grade). A total of 401,517 children were included in the analyses with annual repeated cross-sectional data covering the period from 2012 to 2018. The effect of the school policy was evaluated using an interrupted time series approach comparing pre- and post-policy slopes in BMI, stratified by sex and age-group. Results In boys, no significant differences were observed in mean BMI slopes from pre-to post-policy in either age-group. In girls, post-policy slopes were significantly higher compared to pre-policy in both age-groups (0th-3rd grade: β:0·034 kg/m2, 95%-CI: (0·024; 0·043), p-value: <0·001; 7th-9th grade: β:0·066 kg/m2, 95%-CI: (0·028; 0·103), p-value: 0·001). No significant differences in slopes were observed in BMI at the 90th percentile from pre-to post-policy for both sexes and across both age-groups. Adjustment for leisure-time physical activity as a potential time-varying confounder did not alter the findings. Conclusions In conclusion, we did not detect a significant decrease in BMI levels among school-aged children following the introduction of a nationwide school policy specifying daily physical activity in school. If anything, a small positive change in BMI was observed in girls. More research is needed to understand whether structural changes similar to this requirement are able to prevent overweight and obesity in children and adolescents.
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Affiliation(s)
- Natascha H. Pedersen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Niels C. Møller
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Data Science and Statistics, Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Kristian T. Larsen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan C. Brønd
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jens Troelsen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren Brage
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- MRC Epidemiology Unit, University of Cambridge, Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jacob v B. Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Niels Wedderkopp
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars B. Christiansen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sofie R. Mortensen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Heidi K. Egebæk
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mette Toftager
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Malene S. Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Peter L. Kristensen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Hall A, Lane C, Wolfenden L, Wiggers J, Sutherland R, McCarthy N, Jackson R, Shoesmith A, Lecathelinais C, Reeves P, Bauman A, Gillham K, Boyer J, Naylor PJ, Kerr N, Kajons N, Nathan N. Evaluating the scaling up of an effective implementation intervention (PACE) to increase the delivery of a mandatory physical activity policy in primary schools. Int J Behav Nutr Phys Act 2023; 20:106. [PMID: 37674213 PMCID: PMC10481546 DOI: 10.1186/s12966-023-01498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Physically Active Children in Education (PACE) is an effective implementation intervention for increasing the number of minutes classroom teachers schedule physical activity each week. To date, evaluations of PACE have included a smaller number of schools from only one region in New South Wales Australia. If PACE is to have population-wide benefits we must be able to deliver this support to a larger number of schools across multiple regions. This study aimed to evaluate the scale-up of PACE. METHODS An uncontrolled before and after study, with 100 schools from three regions was conducted. Participating schools received PACE for approximately 12 months. We assessed the following outcomes: delivery of the evidence-based intervention (EBI) (i.e. minutes of physical activity scheduled by classroom teachers per week); delivery of the implementation strategies (i.e. reach, dose delivered, adherence and indicators of sustainability); and key determinants of implementation (i.e. acceptability of strategies and cost). Data were collected via project officer records, and principal and teacher surveys. Linear mixed models were used to assess EBI delivery by evaluating the difference in the mean minutes teachers scheduled physical activity per week from baseline to follow-up. Descriptive data were used to assess delivery of the implementation strategies and their perceived acceptability (i.e. PACE). A prospective, trial-based economic evaluation was used to assess cost. RESULTS Delivery of the EBI was successful: teachers increas their average minutes of total physical activity scheduled across the school week by 26.8 min (95% CI: 21.2, 32.4, p < 0.001) after receiving PACE. Indicators for delivery of implementation strategies were high: 90% of consenting schools received all strategies and components (reach); 100% of strategies were delivered by the provider (dose); >50% of schools adhered to the majority of strategies (11 of the 14 components); and acceptability was > 50% agreement for all strategies. The incremental cost per additional minute of physical activity scheduled per week was $27 per school (Uncertainty Interval $24, $31). CONCLUSIONS PACE can be successfully delivered across multiple regions and to a large number of schools. Given the ongoing and scalable benefits of PACE, it is important that we continue to extend and improve this program while considering ways to reduce the associated cost.
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Affiliation(s)
- Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia.
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nicole McCarthy
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rebecca Jackson
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Adrian Bauman
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Karen Gillham
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
| | - James Boyer
- School Sport Unit, NSW Department of Education, Turrella, NSW, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Nicola Kerr
- Health Promotion, Mid North Coast Local Health District, Coffs Harbour, Australia
| | - Nicole Kajons
- Health Promotion and Population Health Improvement, Central Coast Local Health District, Gosford, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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3
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Pedersen NH, Grøntved A, Brønd JC, Møller NC, Larsen KT, Debrabant B, Koch S, Troelsen J, Brage S, Schipperijn J, Hjelmborg J, Wedderkopp N, Christiansen LB, Kristensen PL. Effect of nationwide school policy on device-measured physical activity in Danish children and adolescents: a natural experiment. THE LANCET REGIONAL HEALTH. EUROPE 2023; 26:100575. [PMID: 36895450 PMCID: PMC9989658 DOI: 10.1016/j.lanepe.2022.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
Background A new Danish school policy with a requirement for 45 min physical activity daily during school hours was introduced in 2014. The objective of this natural experiment was to evaluate the effect of this nationwide school policy on physical activity in Danish children and adolescents. Methods Four historical studies completed between 2009 and 2012 comprised the pre-policy study population. Post-policy data were collected in 2017/18. All post-policy schools were represented in the four pre-policy studies. Age-groups and seasons were matched. In total, 4816 children and adolescents aged 6-17 were included in the analyses (2346 pre-policy and 2470 post-policy). Children and adolescents were eligible if they had accelerometer measurements and did not have any physical disabilities preventing activity. Physical activity was measured by accelerometry. Main outcome was any bodily movement. Secondary outcomes were moderate to vigorous physical activity and overall movement volume (mean counts per minute). Findings The school policy interrupted a linear decreasing pre-policy trend in physical activity during school hours. All activity outcomes increased post-policy during a standardized school day (8:10 am-1 pm). Increases were more pronounced in the youngest children. Specifically, we observed a daily increase during a standardized school day in 2017/2018 of 14.2 min of movement (95% CI: 11.4-17.0, p < 0.001), 6.5 min of moderate to vigorous physical activity (95% CI: 4.7-8.3, P < 0.001), and 141.8 counts per minute (95% CI: 108.5-175.2, P < 0.001). Interpretation A national school policy may be an important strategy to increase physical activity during school hours among children and adolescents. Funding The Danish Foundation TrygFonden has funded the PHASAR project (ID 115606).
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Affiliation(s)
- Natascha H. Pedersen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, 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, Campusvej 55, Odense 5230, Denmark
| | - Jan C. Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Niels C. Møller
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Kristian T. Larsen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Birgit Debrabant
- Data Science and Statistics, Department of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9, Odense C 5000, Denmark
| | - Sofie Koch
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Jens Troelsen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Søren Brage
- MRC Epidemiology Unit, Cambridge School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Jasper Schipperijn
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Jacob Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9, Odense C 5000, Denmark
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Lars B. Christiansen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Peter L. Kristensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
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