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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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