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Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children: A Cluster Randomized Clinical Trial.
Lonsdale, C, Sanders, T, Parker, P, Noetel, M, Hartwig, T, Vasconcellos, D, Lee, J, Antczak, D, Kirwan, M, Morgan, P, et al
JAMA pediatrics. 2021;(7):680-688
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Abstract
IMPORTANCE Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. OBJECTIVE To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. INTERVENTIONS The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). MAIN OUTCOMES AND MEASURES Multistage 20-m shuttle run test for cardiorespiratory fitness. RESULTS Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). CONCLUSIONS AND RELEVANCE In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. TRIAL REGISTRATION http://anzctr.org.au Identifier: ACTRN12616000731493.
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Effects of a cluster-randomized school-based prevention program on physical activity and microvascular function (JuvenTUM 3).
Siegrist, M, Hanssen, H, Lammel, C, Haller, B, Koch, AM, Stemp, P, Dandl, E, Liestak, R, Parhofer, KG, Vogeser, M, et al
Atherosclerosis. 2018;:73-81
Abstract
BACKGROUND AND AIMS It is unknown whether a school-based prevention program has the potential to improve microvascular health in children. This study investigates the impact of the school-based lifestyle intervention program JuvenTUM 3 on physical activity, physical fitness, serum biomarkers and microvascular function. METHODS We studied 434 children (10-11 years) in a cluster-randomized setting (8 intervention schools, IG; 7 control schools, CG) over 18 months. The school-based prevention program included weekly lifestyle lessons for children with the aim to increase physical activity in and outside of school, physical fitness as well as health behavior. Anthropometric measurements and blood sampling were conducted using standard protocols, physical activity by use of a questionnaire and physical fitness by a 6-item-test battery. Central retinal arteriolar (CRAE) and venular (CRVE) vessel diameters as early marker of vascular dysfunction, as well as the arteriolar-to-venular diameter ratio (AVR), were investigated with a non-mydriatic vessel analyser. RESULTS School-based physical activity increased in 41% of children in IG (19% in CG, p = 0.038). Improvements in vascular parameters were observed for AVR (increase in 83% of children in IG versus 50% in CG; p < 0.001) and for CRVE (43% of children with retinal venular widening in IG versus 58% in CG, p = 0.019). These vascular improvements were also seen in overweight children for CRAE (p = 0.021) and AVR (p < 0.001). CONCLUSIONS The school-based prevention program JuvenTUM 3 increased physical activity at school inducing favourable effects on retinal microvasculature function. These findings underline the importance of early lifestyle interventions in children for primary prevention of cardiovascular disease.
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Food intake and appetite following school-based high-intensity interval training in 9-11-year-old children.
Morris, A, Cramb, R, Dodd-Reynolds, CJ
Journal of sports sciences. 2018;(3):286-292
Abstract
Using a randomised cross-over design, free-living lunch intake and subjective appetite were examined in 10 children (9.8 ± 0.6 years) following high-intensity interval training (HIIT) versus a control sedentary (SED) period, within a school setting. The 22-min HIIT took place during a regular PE lesson and consisted of two rounds of 4 × 30 s sprints. Foods were offered at a regular school lunch immediately following HIIT and SED and were matched between conditions. All food was covertly weighed before and after the meal. Hunger, fullness and prospective consumption were reported immediately before and after HIIT/SED, using visual analogue scales. Heart rate was higher during HIIT than SED (159.3 ± 23.1 vs. 76.9 ± 2.2 bpm, P < 0.05). Lunch energy intake was not different (P = 0.52) following HIIT, compared to SED (2.06 ± 0.35 vs. 2.09 ± 0.29 MJ, respectively). There were no significant differences in macronutrient intake or subjective appetite (P > 0.05). Results suggest that HIIT can be implemented in a PE lesson immediately before lunch, without causing a compensatory increase in food consumption.
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Improving Physical Fitness and Cognitive Functions in Middle School Students: Study Protocol for the Chinese Childhood Health, Activity and Motor Performance Study (Chinese CHAMPS).
Zhou, Z, Dong, S, Yin, J, Fu, Q, Ren, H, Yin, Z
International journal of environmental research and public health. 2018;(5)
Abstract
Background: Sedentary lifestyles and their associated harmful consequences are public health concerns that impact more than half of the world's youth population in both developed and developing countries. Methods: The Chinese Childhood Health; Activity and Motor Performance Study (Chinese CHAMPS) was a cluster randomized controlled trial to modify school physical activity policies and the physical education (PE) curriculum; using teacher training and parent engagement to increase opportunities and support students' physical activity and healthy eating. Using a 2 × 2 factorial design, the study tested the incremental effects of increasing the amount and intensity of physical activity, alongside adding support for healthy eating, on health-related and cognitive function outcomes in Chinese middle school students. Results: The intervention was implemented by PE teachers in 12 middle schools in three Chinese cities, with a targeted enrollment of 650 students from August 2015⁻June 2016. The assessment of the outcomes involved a test battery of physical fitness and cognitive functioning at both baseline and at the end of the intervention. Process information on implementation was also collected. Discussion: The Chinese CHAMPS is a multi-level intervention that is designed to test the influences of policy and environmental modifications on the physical activity and eating behaviors of middle school students. It also addresses some key weaknesses in school-based physical activity interventions.
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Strength exercises during physical education classes in secondary schools improve body composition: a cluster randomized controlled trial.
Ten Hoor, GA, Rutten, GM, Van Breukelen, GJP, Kok, G, Ruiter, RAC, Meijer, K, Kremers, SPJ, Feron, FJM, Crutzen, R, Schols, AMJW, et al
The international journal of behavioral nutrition and physical activity. 2018;(1):92
Abstract
BACKGROUND Metabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school curriculum- on adolescents body composition and daily physical activity. METHODS A total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome. RESULTS After 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p = .007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p = .041) and 0.7 kg difference in fat mass (intervention CONCLUSION In 11-15 year olds, the combination of strength exercises plus motivational lessons contributed to an improvement in body composition and a smaller decrease in physical activity level. TRIAL REGISTRATION ID ( NTR5676 - retrospectively registered 8 February 2016; enrolment of first participant: 2 March 2015).
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Exposing athletes to playing form activity: outcomes of a randomised control trial among community netball teams using a game-centred approach.
Miller, A, Harvey, S, Morley, D, Nemes, R, Janes, M, Eather, N
Journal of sports sciences. 2017;(18):1-12
Abstract
This study evaluated whether exposing junior netball players to greater amounts of competition relevant activity (playing form activity) had an effect on game play outcomes and session involvement. A group-randomised controlled trial in one junior netball club in the Hunter Region, NSW, Australia. Ninety female athletes (mean age = 9.04 years, SD 1.53) were randomised by team (n = 11) into the intervention (n = 41) or 9-week wait-list control (n = 49) condition. The Professional Learning for Understanding Games Education into Sport (PLUNGE into Sport) programme was undertaken in the first half of nine training sessions (9 × 30 min). The intervention exposed athletes to playing form activity through a coach development programme within training sessions. Athletes' decision-making, support and skill outcomes during a small-sided invasion game, and session involvement (pedometer step/min), were measured at baseline and 9-week follow-up. Linear mixed models revealed significant group-by-time intervention effects (P < 0.05) for decision-making (d = 0.4) and support (d = 0.5) during game play, and in-session activity (d = 1.2). An intervention exposing athletes to greater levels of playing form activity, delivered via a coach education programme, was efficacious in improving athlete decision-making and support skills in game play and increasing athlete involvement during sessions.
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Impact of a Home-Based Physical and Nutritional Intervention Program Conducted by Lay-Volunteers on Handgrip Strength in Prefrail and Frail Older Adults: A Randomized Control Trial.
Haider, S, Dorner, TE, Luger, E, Kapan, A, Titze, S, Lackinger, C, Schindler, KE
PloS one. 2017;(1):e0169613
Abstract
A randomized controlled trial was performed to compare the effects of a home-based physical and nutritional intervention program carried out by lay-volunteers to home visits with social support alone. Buddies visited 80 prefrail or frail older persons at home twice a week for 12 weeks. The physical training and nutrition group (PTN, n = 39) performed two sets of six strength exercises, discussed nutritional topics and received social support. The social support group (SoSu, n = 41) received home visits with social support only. In the PTN group, handgrip strength increased significantly by 2.4 kg (95% CI: 1.0-3.8). In the SoSu group we did not see a significant improvement. However, no significant between-group difference was found. Physical performance increased in both groups, although with a higher increase of 1.0 point (95% CI: 0.1-2.0) in the PTN group. In none of the groups muscle mass changed. Further results showed that frail individuals benefit more from the intervention than prefrail individuals (OR: 2.78; 95% CI: 1.01-7.66). Handgrip strength in the intervention group increased by a clinically relevant value and this effect is comparable to that obtained by health-care professionals. Therefore, home visits with a physical training and nutritional program could offer a new perspective in the care of community-dwelling prefrail and frail older persons.
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Evidence of disturbed sleep and mood state in well-trained athletes during short-term intensified training with and without a high carbohydrate nutritional intervention.
Killer, SC, Svendsen, IS, Jeukendrup, AE, Gleeson, M
Journal of sports sciences. 2017;(14):1402-1410
Abstract
Few studies have investigated the effects of exercise training on sleep physiology in well-trained athletes. We investigated changes in sleep markers, mood state and exercise performance in well-trained cyclists undergoing short-term intensified training and carbohydrate nutritional intervention. Thirteen highly-trained male cyclists (age: 25 ± 6y, [Formula: see text]O2max: 72 ± 5 ml/kg/min) participated in two 9-day periods of intensified training while undergoing a high (HCHO) or moderate (CON) carbohydrate nutritional intervention before, during and after training sessions. Sleep was measured each night via wristwatch actigraphy. Mood state questionnaires were completed daily. Performance was assessed with maximal oxygen uptake ([Formula: see text]. Percentage sleep time fell during intensified training (87.9 ± 1.5 to 82.5 ± 2.3%; p < 0.05) despite an increase in time in bed (456 ± 50 to 509 ± 48 min; p = 0.02). Sleep efficiency decreased during intensified training (83.1 ± 5.3 to 77.8 ± 8.6%; p < 0.05). Actual sleep time was significantly higher in CON than HCHO throughout intensified training. Mood disturbance increased during intensified training and was higher in CON than HCHO (p < 0.05). Performance in the [Formula: see text] exercise protocol fell significantly with intensified training. The main findings of this study were that 9-days of intensified training in highly-trained cyclists resulted in significant and progressive declines in sleep quality, mood state and maximal exercise performance.
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Clustered randomised controlled trial of two education interventions designed to increase physical activity and well-being of secondary school students: the MOVE Project.
Tymms, PB, Curtis, SE, Routen, AC, Thomson, KH, Bolden, DS, Bock, S, Dunn, CE, Cooper, AR, Elliott, JG, Moore, HJ, et al
BMJ open. 2016;(1):e009318
Abstract
OBJECTIVE To assess the effectiveness of 2 interventions in improving the physical activity and well-being of secondary school children. DESIGN A clustered randomised controlled trial; classes, 1 per school, were assigned to 1 of 3 intervention arms or a control group based on a 2×2 factorial design. The interventions were peer-mentoring and participative learning. Year 7 children (aged 11-12) in the peer-mentoring intervention were paired with year 9 children for 6 weekly mentoring meetings. Year 7 children in the participative learning arm took part in 6 weekly geography lessons using personalised physical activity and Global Positioning System (GPS) data. Year 7 children in the combined intervention received both interventions, with the year 9 children only participating in the mentoring sessions. PARTICIPANTS 1494 year 7 students from 60 schools in the North of England took part in the trial. Of these, 43 students opted out of taking part in the evaluation measurements, 2 moved teaching group and 58 changed school. Valid accelerometry outcome data were collected for 892 students from 53 schools; and well-being outcome data were available for 927 students from 52 schools. MAIN OUTCOME MEASURES The primary outcomes were mean minutes of accelerometer-measured moderate-to-vigorous intensity physical activity per day, and well-being as evaluated by the KIDSCREEN-27 questionnaire. These data were collected 6 weeks after the intervention; a 12-month follow-up is planned. RESULTS No significant effects (main or interaction) were observed for the outcomes. However, small positive differences were found for both outcomes for the participative learning intervention. CONCLUSIONS These findings suggest that the 2 school-based interventions did not modify levels of physical activity or well-being within the period monitored. Change in physical activity may require more comprehensive individual behavioural intervention, and/or more system-based efforts to address wider environmental influences such as family, peers, physical environment, transport and educational policy. TRIAL REGISTRATION NUMBER ISRCTN82956355.
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Impact of a school-based intervention on nutritional education and physical activity in primary public schools in Chile (KIND) programme study protocol: cluster randomised controlled trial.
Bustos, N, Olivares, S, Leyton, B, Cano, M, Albala, C
BMC public health. 2016;(1):1217
Abstract
BACKGROUND Chile has suffered a fast increase in childhood obesity in the last 10 years. As a result, several school programmes have been implemented, however the effectiveness of these needs to be evaluated to identify and prioritize strategies to curve this trend. METHODS Cluster randomized controlled trial. Twelve primary public schools chosen at random over three regions of the country will take part in this study. The sample size consisted of a total of 1,655 children. For each region one school will be selected for each of the three nutritional intervention modes and one school will be selected as the control group. The intervention modes consist of the following: Healthy Kiosk and nutritional education (KSEAN); Optimized physical activity (AFSO); Healthy Kiosk and nutritional education (KSEAN) + optimized physical activity (AFSO); Control group. The effectiveness of each intervention will be evaluated by determining the nutritional condition of each child by measuring percentage of body fat, BMI and the z-score of the BMI. This study will also identify the eating behaviours, nutritional knowledge and fitness of each child, along with the effective time of moderate activity during physical education classes. DISCUSSION A protocol to evaluate the effectiveness of a school based intervention to control and/or reduce the rates of childhood obesity for children between 6 and 10 years of age was developed. The protocol was developed in line with the Declaration of Helsinski, the Nüremberg Code and the University of Chile Guidelines for ethical committees, and was approved by the INTA, Universidad de Chile ethical committee on Wednesday 12 March 2014. There is consensus among researchers and health and education personnel that schools are a favourable environment for actions to prevent and/or control childhood obesity. However a lack of evidence on the effectiveness of interventions to date has led some to question the wisdom of allocating resources to programmes. This is the first study of this kind in Chile and could be an important first step to provide guidance to political authorities in relation to which food and nutrition strategies to prioritize to curve this alarming trend. TRIAL REGISTRATION ISRCTN32136790 , registered retrospectively on 05 September 2014.