Intervention Effects of the Health Promotion Programme "Join the Healthy Boat" on Objectively Assessed Sedentary Time in Primary School Children in Germany

Co-construct, implement and evaluate a multi-level intervention to prevent a sedentary lifestyle in children-Study protocol of the CIPRES study

BACKGROUND

A sedentary lifestyle is commonly associated with a higher risk of chronic disease development. Among school-aged children from European countries, screen-time represents a significant portion of sedentary time with 39.8% of children spending more than 2h/day in front of a screen on average. Therefore, effective solutions to reduce sedentary behavior (SB) must be found. Multilevel interventions based on the socio-ecological model (SEM) are particularly relevant to take into account influences of the social environment on individuals' SB. Moreover, the trans-contextual model (TCM) can offer complementary levers for individuals' behavior change. The CIPRES study is a theory-based multilevel intervention designed to decrease the SB in French primary school children aged 8-10 years. The present paper describes the protocol of a randomized controlled study to evaluate the effectiveness of the CIPRES multilevel intervention on SB.

METHODS

The CIPRES study is a cluster-randomized controlled trial comparing intervention vs control groups. A total of 700 children are targeted for inclusion, distributed in four municipalities considered as clusters. The study consists of two successive phases: 1) co-building of a SB prevention intervention by using a participatory approach involving representatives of each level of the SEM (e.g., children, parents, staff from municipalities, teachers) and 2) implementation and evaluation of the intervention. The intervention will last for 6 weeks in each involved class. Primary outcome will be the sedentary time of children per week, assessed by accelerometry. In addition, children and their parents will be asked to fill out questionnaires concerning children's physical activity level, screen time, quality-of-life and variables of the TCM.

DISCUSSION

This study will give information on the effectiveness of a theory-based intervention, involving multiple levels of actors in the co-construction and the implementation of the intervention, that may interest schools and public health officers looking for innovative sedentary prevention programs.

Objectively assessed school-based intervention to reduce children's sedentary time: a systematic review

Childhood is a period characterized by a constant increase in sedentary time (ST) but also provides a great window of opportunity for children to learn how to limit ST. As a result, school-based interventions aimed at reducing and preventing children's ST are increasingly becoming more widespread. A previous review found that school-based multi-component interventions appeared to be more effective in comparison to those based on a single component. However, this conclusion was based on just 11 studies published before 2016 and needs to be verified due to the currently growing number of studies on this topic. The objective of this systematic review is to update the evaluation of the effectiveness of school-based interventions published since the previous review according to the PRISMA guidelines. Studies published between August 2015 and August 2023 containing objective measures of ST were analyzed. Of the 18 studies identified, 11 (61.1%) reported significant positive results. Multi-component studies were slightly more effective than their single-component equivalent (63.7% vs. 57.1%). The components that proved the most effective of the multi-component studies were the implementation of sit-to-stand desks (100%), and teachers' training (77.8%). The combination of these two components is the most promising method to limit ST in the school context. Future research should determine how sit-to-stand desks can be introduced into the class environment and how courses can be adapted to this material.

School-Based Family-Oriented Health Interventions to Promote Physical Activity in Children and Adolescents: A Systematic Review

OBJECTIVE

This study aimed to systematically review and analyse intervention programs in a school context centred on the family, focused on increasing youths' physical activity.

DATA SOURCE

The research was carried out in the PubMed, Scopus and Web of Science databases.

STUDY INCLUSION CRITERIA

Studies were included if participants were children or adolescents, focusing on school-based intervention studies with parental involvement and physical activity, sedentary behaviour or physical fitness outcomes.

DATA EXTRACTION

The search was performed according to the PRISMA protocol. A total of 416 articles were identified. After being considered for eligibility and duplicates, 22 studies were identified as relevant for inclusion.

DATA SYNTHESIS

Sample and intervention characteristics, objective, the role of the family, outcomes measures, main findings regarding the outcomes and risk of bias.

RESULTS

Ten studies reported improvements in physical activity, 6 in sedentary behaviour and 9 in the components of physical fitness and/or skills related to healthy behaviours and lifestyles. Most of the interventions adopted a multidisciplinary and multi-component approach.

CONCLUSIONS

Most interventions employed a school's multidisciplinary/multi-component approach to promoting physical activity, nutrition, and general education for healthier lifestyle behaviours. The impact of school-based interventions involving families on youth's physical activity levels is still a relatively emerging theme. Further research is needed given the diversity of the intervention's characteristics and the disparity in the results' efficacy.

Effectiveness of school-based interventions targeting physical activity and sedentary time among children: a systematic review and meta-analysis of accelerometer-assessed controlled trials

OBJECTIVES

To date, no meta-analysis has examined the influence of specific intervention characteristics in the overall effectiveness of school-based interventions measured only with accelerometer devices. Thus, the main purpose of this systematic review and meta-analysis was to evaluate the overall and specific variables of the effectiveness of school-based interventions assessed with accelerometer devices among children aged 5-12 years.

STUDY DESIGN

A systematic review and meta-analysis to assess the effectiveness of school-based interventions.

METHODS

Studies published in English, French and Spanish from five electronic databases between January 2010 and December 2021 were identified. Intervention designs with control group measure that assessed daily moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with accelerometer devices in children aged 5-12 years were included.

PROSPERO ID

CRD42022326859.

RESULTS

A total of 24 trials comprising of 19,487 children (51.3% girls) were included. Intervention studies were ineffective for improving daily MVPA (Hedges' g = 0.07, 95% confidence interval [CI] -0.03 to 0.17; I² = 84.80%) but were effective for reducing ST (g = -0.08, 95% CI -0.12 to -0.03; I² = 20.94%). Also, subgroup analyses for MVPA revealed that when studies had two intervention components (g = 0.21, 95% CI 0.06-0.36; I² = 77.67%), and high quality (g = 0.12, 95% CI 0.01-0.22; I² = 88.30%) they were effective.

CONCLUSION

School-based interventions have been effective to reduce children's daily time spent in ST. There is no evidence of overall effectiveness of school-based interventions for enhancing daily MVPA in children. Nevertheless, improving the quality of interventions and interventions with two components are effective to increase students' daily MVPA.

The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions

BACKGROUND

Sedentary behavior is an important risk factor for several chronic diseases and is associated with an increased risk of mortality. We assessed the effectiveness of interventions to reduce sedentary time in Germany and provide recommendations on interventions to reduce sedentary time in children and adults.

METHODS

We comprehensively searched PubMed, Web of Science and the German Clinical Trials Register up to April 2022 for intervention studies targeting sedentary behavior in Germany. We performed a systematic review and qualitative synthesis of the interventions and a meta-analysis in children.

RESULTS

We included 15 studies comprising data from 4588 participants. The results of included primary studies in adults and children showed inconsistent evidence regarding change in sedentary time, with a majority of studies reporting non-significant intervention effects. The meta-analysis in children showed an increase in sedentary time for children in the control and intervention groups.

CONCLUSION

We found inconsistent evidence regarding the effectiveness of interventions to reduce time spent sedentary and our meta-analysis showed an increase in sedentary time in children. For children, we recommend physical and social environment interventions with an active involvement of families. For adults, we recommend physical environment interventions, such as height-adjustable desks at work.

Educational Programs for the Promotion of Health at School: A Systematic Review

Context: Health promotion programs generate healthy changes in the educational community. However, not all of them meet the expected objectives due to multiple factors that affect their development, such as the teachers overload work, the lack of specific training, the lack of time to carry out health promotion activities, the lack of flexibility of the programs, and their non-inclusion in the training programs of the centers. Objective: To know the scope of the strategies and programs that promote healthy habits among students in compulsory educational stages. Data sources: a systematic review of articles in English, using the Web of Science (WOS), Medline, and PsycINFO databases.

Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis

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.