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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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Partnerships for Active Children in Elementary Schools: Outcomes of a 2-Year Pilot Study to Increase Physical Activity During the School Day.
Weaver, RG, Webster, CA, Egan, C, Campos, CMC, Michael, RD, Vazou, S
American journal of health promotion : AJHP. 2018;(3):621-630
Abstract
PURPOSE To evaluate the impact of the pilot study Partnerships for Active Children in Elementary Schools on the percentage of children achieving the Institute of Medicine guideline of 30 minutes of moderate-to-vigorous physical activity (MVPA) during the school day. DESIGN Pre/multiple post-quasi-experimental. SETTING Four elementary schools. PARTICIPANTS Physical education (n = 3) and classroom teachers (n = 12) and students (n = 229). INTERVENTION Partnerships for Active Children in Elementary Schools was a multicomponent, theory-driven intervention facilitated through school-university partnerships. Intervention approaches included communities of practice, community-based participatory research, and service learning. MEASURES Accelerometer-derived percentage of children accumulating 30 minutes of MVPA during the school day. ANALYSIS Multilevel mixed-effects regression estimated MVPA differences over time. RESULTS Compared to control, a 2.4% (95% confidence interval [CI]: -0.0% to 4.8%) and 8.8% (95% CI: -0.3% to 15.4%) increase in the percentage of time girls and boys engaged in MVPA during the school day was observed. The percentage of boys and girls in the intervention group achieving 30 minutes of MVPA/day increased from 57.5% to 70.7% and 35.4% to 56.9%, respectively. Boys and girls in the control group decreased from 61.5% to 56.4% and 52.6% to 41.9%, respectively. However, these changes did not reach statistical significance. CONCLUSION Partnerships for Active Children in Elementary Schools demonstrated meaningful impact on children's MVPA during the school day by increasing boys' and girls' MVPA. However, additional strategies may be required to help schools achieve the Institute of Medicine guideline.
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Promoting elementary physical education: results of a school-based evaluation study.
Boyle-Holmes, T, Grost, L, Russell, L, Laris, BA, Robin, L, Haller, E, Potter, S, Lee, S
Health education & behavior : the official publication of the Society for Public Health Education. 2010;(3):377-89
Abstract
Using a quasiexperimental design, the authors examine whether fourth- and fifth-grade students exposed to a developmental physical education (PE) curriculum, Michigan's Exemplary Physical Education Curriculum (EPEC), demonstrated stronger motor skill-specific self-efficacy and perceptions of physical activity competence, physical activity levels, motor skills, and physical fitness than did students exposed to existing PE curricula. The authors conducted a multilevel regression analysis with data from 1,464 students in the fourth and fifth grades. Data were collected using a student survey, an activity checklist, and motor and fitness assessments. Compared to students receiving standard PE, students exposed to EPEC showed significantly stronger results in motor skills but not fitness outcomes. The authors found significant positive intervention effects on indicators of motor skill self-efficacy and physical activity levels among the fourth-grade cohort. EPEC was more effective than standard PE curricula at improving motor skill performance (fourth- and fifth-grade cohorts) and at increasing self-reported motor skill-specific self-efficacy and physical activity (fourth-grade cohort).
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Rationale, design and methods of the HEALTHY study physical education intervention component.
McMurray, RG, Bassin, S, Jago, R, Bruecker, S, Moe, EL, Murray, T, Mazzuto, SL, Volpe, SL, ,
International journal of obesity (2005). 2009;(Suppl 4):S37-43
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The HEALTHY primary prevention trial was designed to reduce risk factors for type 2 diabetes in middle school students. Middle schools at seven centers across the United States participated in the 3-year study. Half of them were randomized to receive a multi-component intervention. The intervention integrated nutrition, physical education (PE) and behavior changes with a communications strategy of promotional and educational materials and activities. The PE intervention component was developed over a series of pilot studies to maximize student participation and the time (in minutes) spent in moderate-to-vigorous physical activity (MVPA), while meeting state-mandated PE guidelines. The goal of the PE intervention component was to achieve > or =150 min of MVPA in PE classes every 10 school days with the expectation that it would provide a direct effect on adiposity and insulin resistance, subsequently reducing the risk of type 2 diabetes in youth. The PE intervention component curriculum used standard lesson plans to provide a comprehensive approach to middle school PE. Equipment and PE teacher assistants were provided for each school. An expert in PE at each center trained the PE teachers and assistants, monitored delivery of the intervention and provided ongoing feedback and guidance.
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Impact of curriculum-based bone loading and nutrition education program on bone accrual in children.
Nichols, DL, Sanborn, CF, Essery, EV, Clark, RA, Letendre, JD
Pediatric exercise science. 2008;(4):411-25
Abstract
The purpose of this study was to investigate the influence of jumping activities and nutrition education on bone accretion in prepubescents. Fourth-grade children were divided into four groups: jumping (n = 61), nutrition (n = 9), jumping plus nutrition (n = 14), and control (n = 28). Interventions spanned the fourth and fifth grade academic years. Assessments were gathered at 0, 8 and 20 months. Baseline BMD values were (mean +/- SD): lumbar (0.752 +/- 0.095 g/cm2), neck (0.794 +/- 0.089 g/cm2) and total (0.907 +/- 0.060 g/cm2). There was a significant increase in BMD over time. However, the interventions produced no significant effects. Twice weekly jumping and/or biweekly nutrition education did not influence bone accrual.