A scoping review of adherence to WHO health promoting school framework by school-based interventions to promote physical activity and cardiorespiratory fitness among 6- to 10-year-old children

IntroductionPhysical inactivity is known as a leading cause of mortality and tracks from childhood to adulthood. Many types of school-based single-component and multicomponent interventions to promote physical activity (PA) have been undertaken and evaluated, with mixed findings overall. Enlarging the intervention areas beyond the school setting is a promising approach. WHO’s Health Promoting School (WHO HPS) framework is a holistic, setting-based approach where health is promoted through the whole school environment with links to other settings such as the home environment and wider community. In this paper, we outline our scoping review protocol to systematically review the published literature from the last 10 years to identify existing school-based interventions to promote PA and cardiorespiratory fitness among children aged 6–10 years old and to map intervention components according to the features of this framework.Methods and analysisArksey and O’Malley’s scoping review methodology framework will guide the conduct of this review. We will search Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sports Medicine & Education Index, Education Resources Information Centre and CENTRAL and hand search the reference lists of key studies to identify studies appropriate for inclusion. Any empirical study that evaluated the effectiveness of a school-based intervention promoting PA and/or cardiorespiratory fitness in children aged 6–10 years old will be included. Two reviewers will independently screen all abstracts and full texts for inclusion. One reviewer will extract general information, study characteristics and intervention contents to classify them according to the features of the WHO HPS framework. Results will be synthesised narratively.Ethics and disseminationFindings will be disseminated in conference presentations and peer-reviewed publications. A condensed version of the results will be made available for the public. Stakeholder meetings will be arranged to discuss and disseminate the findings.

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Long-Term Dietary and Physical Activity Interventions in the School Setting and Their Effects on BMI in Children Aged 6–12 Years: Meta-Analysis of Randomized Controlled Clinical Trials

Healthcare ◽

10.3390/healthcare9040396 ◽

2021 ◽

Vol 9 (4) ◽

pp. 396

Author(s):

Purificación Cerrato-Carretero ◽

Raúl Roncero-Martín ◽

Juan D. Pedrera-Zamorano ◽

Fidel López-Espuela ◽

Luis M. Puerto-Parejo ◽

...

Keyword(s):

Physical Activity ◽

Clinical Trials ◽

Dietary Habits ◽

Meta Analysis ◽

Controlled Clinical Trials ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled ◽

School Based ◽

School Based Interventions

Preventive actions and potential obesity interventions for children are mainly researched throughout the school period, either as part of the school curricula or after regular school hours, via interventions mostly lasting less than 12 months. We aimed to perform a meta-analysis on randomized controlled clinical trials to evaluate the evidence of the efficacy of long-term school-based interventions in the management of childhood obesity in terms of BMI from a dietary and physical activity-based approach. Eleven randomized controlled clinical trials were examined using the random effects model, and the results showed that there were no significant effects associated with physical activity + nutrition intervention in school children aged 6–12 years, with a pooled standardized mean difference (SMD) (95% CI) of −0.00 (−0.05, 0.04). No effects were observed after subgroup analysis based on the intervention length. The findings from our study indicate that long-term school-based interventions on physical activity and dietary habits received by children aged 6–12 years seem to have no effect on BMI. However, the promotion of such interventions should not be discouraged, as they promote additional positive health outcomes for other domains of children’s health.

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Abstract 17944: Effects of School-Based Interventions on Body Mass Index in Children and Adolescents: a Systematic Overview and Meta-analysis

Circulation ◽

10.1161/circ.130.suppl_2.17944 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jiyoon J Park ◽

Randa Bakhet ◽

Danica Karl ◽

Fei Yuan ◽

Eva Lonn

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Childhood Obesity ◽

Body Mass ◽

Meta Analysis ◽

Control Groups ◽

School Based ◽

School Based Interventions ◽

The Difference ◽

Dietary Modifications

Background: Childhood obesity is a major public health threat. Various school-based interventions (SBIs) to prevent obesity through physical activity and/or dietary modifications were implemented. However, the effectiveness of such SBIs remains unproven. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) of SBIs. Methods: We searched for RCTs of SBIs published since 1990. To be eligible studies had to have an RCT design, to include children aged 6-18 years and SBIs were defined as non-pharmacological and non-surgical interventions carried out in a school setting with a minimum duration of 12 weeks. The primary outcome was change in body mass index (BMI. For each study the difference in the mean change in BMI between the intervention and the control groups was computed. The summary estimate for the difference in mean change in BMI and the 95% confidence interval (CI) was computed using a weighted inverse variance approach and a random- effects model. The I 2 statistic was used to test for heterogeneity. Results: Of 504 studies identified, 41 involving 42 430 participants met the inclusion criteria. SBIs varied greatly between studies by type, duration and delivery. In 10 RCTs the SBI focused on physical activity, in 6 on dietary modifications and in 25 on both physical activity and dietary modifications. SBIs duration ranged from 12 weeks to 4 years. There was no significant difference in mean BMI change between the intervention and the control groups (mean difference = -0.281kg/m 2 ; 95% CI -0.584 to 0.022), although there was significant heterogeneity between the RCTs’ findings (Figure). We found also no consistent impact on other measures of adiposity, physical activity patterns, dietary intakes and psychosocial health and wellbeing. Conclusions: SBIs had no substantial impact on BMI in children aged 6-18 years. Further research is needed to identify effective interventions to prevent childhood obesity.

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School-Based Interventions Targeting Nutrition and Physical Activity, and Body Weight Status of African Children: A Systematic Review

Nutrients ◽

10.3390/nu12010095 ◽

2019 ◽

Vol 12 (1) ◽

pp. 95 ◽

Cited By ~ 1

Author(s):

Theodosia Adom ◽

Anniza De Villiers ◽

Thandi Puoane ◽

André Pascal Kengne

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Children And Adolescents ◽

Weight Status ◽

Primary School Children ◽

Health Concern ◽

African Children ◽

School Based ◽

School Based Interventions ◽

Nutrition And Physical Activity

Background: Overweight/obesity is an emerging health concern among African children. The aim of this study was to summarise available evidence from school-based interventions that focused on improving nutrition and physical activity knowledge, attitude, and behaviours, and weight status of children aged 6–15 years in the African context. Methods: Multiple databases were searched for studies evaluating school-based interventions of African origin that involved diet alone, physical activity alone, or multicomponent interventions, for at least 12 weeks in duration, reporting changes in either diet, physical activity, or body composition, and published between 1 January 2000 and 31 December 2018. No language restrictions were applied. Relevant data from eligible studies were extracted. Narrative synthesis was used to analyse and describe the data. Results: This systematic review included nine interventions comprising 10 studies. Studies were conducted among 9957 children and adolescents in two African countries, namely South Africa and Tunisia, and were generally of low methodological quality. The sample size at baseline ranged from 28 to 4003 participants. Two interventions reported enrolling children from both urban and rural areas. The majority of the study participants were elementary or primary school children and adolescents in grades 4 to 6. Participants were between the ages of 12.4 and 13.5 years. All but one intervention targeted children of both sexes. Four studies were described as randomised control trials, while five were pre- and post-test quasi-experiments. Except for one study that involved the community as a secondary setting, all were primarily school-based studies. The duration of the interventions ranged from four months to three years. The interventions focused largely on weight-related behaviours, while a few targeted weight status. The results of the effectiveness of these interventions were inconsistent: three of five studies that evaluated weight status (body mass index (BMI), BMI z-score, overweight/obesity prevalence), three of six studies that reported physical activity outcomes (number of sports activities, and physical activity duration ≥ 30 min for at least six days/week), and four of six reporting on nutrition-related outcomes (number meeting fruit and vegetable intake ≥ 5 times/day) found beneficial effects of the interventions. Conclusion: Given the dearth of studies and the inconsistent results, definite conclusions about the overall effectiveness and evidence could not be made. Nonetheless, this study has identified research gaps in the childhood obesity literature in Africa and strengthened the need for further studies, the findings of which would contribute valuable data and inform policy.

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Is an ecological school-based nutrition intervention effective to improve adolescents’ nutrition-related knowledge, attitudes and behaviour in rural areas of China?

Global Health Promotion ◽

10.1177/1757975915626864 ◽

2016 ◽

Vol 24 (4) ◽

pp. 81-89 ◽

Cited By ~ 5

Author(s):

Dongxu Wang ◽

Donald Stewart ◽

Chun Chang

Keyword(s):

Rural Areas ◽

Dietary Habits ◽

Rural China ◽

Nutrition Intervention ◽

Ecological Approach ◽

Control School ◽

Post Intervention ◽

School Based ◽

Health Promoting School ◽

Health Promoting

Purpose: The purpose of this article is to examine the effect of a school-based nutrition intervention using an ecological approach to improve adolescents’ nutrition-related knowledge, attitudes and behaviour in rural China. Methods: A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to the school that was conducting a holistic school-based intervention using health-promoting school (HPS) framework, ‘HPS School’, or to the ‘Control School’ in Mi Yun County, Beijing. From each school we randomly selected 65 seventh-grade students to participate in the study. Their nutrition-related knowledge, attitudes and behaviour were measured by pre- and post-intervention surveys with the same instrument. The nutrition intervention lasted for six months. Results: Adolescents in the intervention school were more likely to know the nutrition knowledge items, with an odds ratio (OR) ranging from 1.86 (95% confidence interval (CI): 1.11–3.09) to 6.34 (95% CI: 3.83–10.47); more likely to think nutrition is very important to health, developing healthy dietary habits is very important, and that expired foods should be thrown away, with ORs of 3.03 (95% CI: 1.60–5.76), 2.76 (95% CI: 1.66–4.59) and 2.35 (95% CI: 1.33–4.17) respectively, and more likely to consume no soft drinks, desserts or fried food, and to eat vegetables every day of the last week, with ORs of 1.99 (95% CI: 1.31–3.04), 3.96 (95% CI: 2.43–6.46), 3.63 (95% CI: 2.26–5.85), and 2.51 (95% CI: 1.41–4.48) respectively, as compared with those in the control school after interventions. Conclusions: Our intervention using the HPS framework, an ecological approach, was an appropriate model to promote nutrition among adolescents in rural China and its use should be advocated in future school-based nutrition promotion programmes for adolescents.

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Associations Between Anthropometric Indicators in Early Life and Cardiorespiratory Fitness, Physical Activity, and Sedentary Time in Adolescence

Journal of Physical Activity and Health ◽

10.1123/jpah.2019-0527 ◽

2020 ◽

Vol 17 (12) ◽

pp. 1213-1221

Author(s):

José Oliveira-Santos ◽

Rute Santos ◽

Carla Moreira ◽

Sandra Abreu ◽

Luís Lopes ◽

...

Keyword(s):

Physical Activity ◽

Birth Weight ◽

Cardiorespiratory Fitness ◽

Early Life ◽

Sedentary Time ◽

Early Years ◽

Anthropometric Data ◽

School Based ◽

Run Test ◽

Shuttle Run

Background: To explore the associations between birth weight and body mass index (BMI) from 6 months to 6 years of age, with cardiorespiratory fitness (CRF), physical activity, and sedentary time in adolescence. Methods: Retrospective school-based study with 539 adolescents (292 girls), mean age of 13.94 (1.62) years. Anthropometric data from birth up to 6 years were extracted from individual child health booklets. CRF was estimated by 20-m shuttle run test. Physical activity and sedentary time were assessed with accelerometers. Results: Birth weight was not associated with any outcome measured in adolescence. From the age of 6 months onwards in girls, and from 3 years in boys, BMI associated inversely with CRF in adolescence. In girls, BMI (at 12 mo and at 3 y of age) associated positively with sedentary time in adolescence, but not with physical activity. In boys, positive associations between BMI at the ages of 3, 5, and 6 years old and time spent in some intensities of physical activity in adolescence were found. Conclusions: BMI during the early years was negatively associated with CRF in adolescence, in a consistent way, for both genders, but with physical activity and sedentary time the associations were scarce and inconsistent, depending on the gender.

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A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-019-0848-8 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 8

Author(s):

Zheng Liu ◽

Han-Meng Xu ◽

Li-Ming Wen ◽

Yuan-Zhou Peng ◽

Li-Zi Lin ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Childhood Obesity ◽

Obesity Prevention ◽

Single Component ◽

Z Score ◽

Physical Activity Interventions ◽

School Based ◽

Prevention Interventions ◽

School Based Interventions

Abstract Background Childhood obesity is a serious public health concern. School-based interventions hold great promise to combat the rising trend of childhood obesity. This systematic review aimed to assess the overall effects of school-based obesity prevention interventions, and to investigate characteristics of intervention components that are potentially effective for preventing childhood obesity. Methods We systematically searched MEDLINE, CENTRAL and Embase databases to identify randomized- or cluster randomized- controlled trials of school-based obesity interventions published between 1990 and 2019. We conducted meta-analyses and subgroup analyses to determine the overall effects of obesity prevention programs and effect differences by various characteristics of intervention components on body mass index (BMI) or BMI Z-score of children. Results This systematic review included a total of 50 trials (reported by 56 publications). Significant differences were found between groups on BMI (− 0.14 kg/m2 (95% confidence interval: − 0.21, − 0.06)) and BMI Z-score (− 0.05 (− 0.10, − 0.01)) for single-component interventions; significant differences were also found between groups on BMI (− 0.32 (− 0.54, − 0.09) kg/m2) and BMI Z-score (− 0.07 (− 0.14, − 0.001)) for multi-component interventions. Subgroup analyses consistently demonstrated that effects of single-component (physical activity) interventions including curricular sessions (− 0.30 (− 0.51, − 0.10) kg/m2 in BMI) were stronger than those without curricular sessions (− 0.04 (− 0.17, 0.09) kg/m2 in BMI); effects of single-component (physical activity) interventions were also strengthened if physical activity sessions emphasized participants’ enjoyment (− 0.19 (− 0.33, − 0.05) kg/m2 in BMI for those emphasizing participants’ enjoyment; − 0.004 (− 0.10, 0.09) kg/m2 in BMI for those not emphasizing participants’ enjoyment). The current body of evidence did not find specific characteristics of intervention components that were consistently associated with improved efficacy for multi-component interventions (P > 0.05). Conclusions School-based interventions are generally effective in reducing excessive weight gain of children. Our findings contribute to increased understandings of potentially effective intervention characteristics for single-component (physical activity) interventions. The impact of combined components on effectiveness of multi-component interventions should be the topic of further research. More high-quality studies are also needed to confirm findings of this review.

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Strategies and effects of school-based interventions to promote active school transportation by bicycle among children and adolescents: a systematic review

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-020-01035-1 ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Dorothea M. I. Schönbach ◽

Teatske M. Altenburg ◽

Adilson Marques ◽

Mai J. M. Chinapaw ◽

Yolanda Demetriou

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Behavior Change ◽

Weight Status ◽

Intervention Group ◽

School Travel ◽

Behavior Change Techniques ◽

School Based ◽

Active School Travel ◽

School Based Interventions

Abstract Background Promoting cycling to school may benefit establishing a lifelong physical activity routine. This systematic review aimed to summarize the evidence on strategies and effects of school-based interventions focusing on increasing active school transport by bicycle. Methods A literature search based on “PICo” was conducted in eight electronic databases. Randomized and non-randomized controlled trials with primary/secondary school students of all ages were included that conducted pre-post measurements of a school-based intervention aimed at promoting active school travel by bicycle and were published in English between 2000 and 2019. The methodological quality was assessed using the “Effective Public Health Practice Project” tool for quantitative studies. Applied behavior change techniques were identified using the “BCT Taxonomy v1”. Two independent researchers undertook the screening, data extraction, appraisal of study quality, and behavior change techniques. Results Nine studies investigating seven unique interventions performed between 2012 and 2018 were included. All studies were rated as weak quality. The narrative synthesis identified 19 applied behavior change techniques clustered in eleven main groups according to their similarities and a variety of 35 different outcome variables classified into seven main groups. Most outcomes were related to active school travel and psychosocial factors, followed by physical fitness, physical activity levels, weight status, active travel and cycling skills. Four studies, examining in total nine different outcomes, found a significant effect in favor of the intervention group on bicycle trips to school (boys only), percentage of daily cycling trips to school, parental/child self-efficacy, parental outcome expectations, moderate-to-vigorous intensity physical activity (total, from cycling, before/after school), and total basic cycling skills. Seven of these outcomes were only examined in two studies conducting the same intervention in children, a voluntary bicycle train to/from school accompanied by adults, including the following clustered main groups of behavior change techniques: shaping knowledge, comparison of behavior, repetition and substitution as well as antecedents. Conclusions The applied strategies in a bicycle train intervention among children indicated great potential to increase cycling to school. Our findings provide relevant insights for the design and implementation of future school-based interventions targeting active school transport by bicycle. Trial registration This systematic review has been registered in the international prospective register of systematic reviews “PROSPERO” at (registration number: CRD42019125192).

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Objectively Determined Physical Activity Levels in German Primary School Children after a One Year School-based Health Promoting Intervention

Journal of Childhood Obesity ◽

10.21767/2572-5394.100029 ◽

2017 ◽

Vol 2 (2) ◽

Author(s):

Susanne Kobel ◽

Sarah Kettner ◽

Jens Dreyhaupt ◽

Jurgen M. Steinacker

Keyword(s):

Physical Activity ◽

Primary School ◽

School Children ◽

Primary School Children ◽

Activity Levels ◽

School Based ◽

Physical Activity Levels ◽

Health Promoting ◽

One Year

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Get(ting) to the Start Line – the evaluation of an innovative intervention to address adolescents’ school-related stress and anxiety

European Physical Education Review ◽

10.1177/1356336x20902487 ◽

2020 ◽

Vol 26 (3) ◽

pp. 642-663 ◽

Cited By ~ 1

Author(s):

Lorraine Cale ◽

Jo Harris ◽

Oliver Hooper

Keyword(s):

Physical Activity ◽

Psychological Health ◽

Online Survey ◽

Well Being ◽

Post Intervention ◽

School Based ◽

East Midlands ◽

Start Line ◽

School Based Interventions ◽

Related Stress

There are growing concerns over young people’s mental health, the academic pressures they face, and the association between school-related stress and health. Given this, alongside the known benefits of physical activity for psychological health, the need for school-based interventions with a physical activity focus seems justified. This paper reports on findings from the evaluation of a pilot of ‘Get to the Start Line’, an innovative school-based programme designed to address adolescents’ school-related stress and anxiety. The research adopted a mixed-methods approach and a pre- and post- design. Six schools from the East Midlands, UK, and selected year 11 pupils (aged 15–16) identified as experiencing examination-related stress and anxiety, participated in the programme. The programme was coordinated by a school champion (a staff member), delivered by an athlete mentor, and comprised six workshops. Data were collected from school champions and athlete mentors via an online survey following each workshop, and via semi-structured focus groups and interviews with pupils and school champions, respectively, pre-, mid- and post-intervention. Schools also provided relevant pupil data. The findings revealed the programme to be positively received by most pupils and to result in positive outcomes such as reported reductions in examination-related stress and anxiety for some, and fewer pupil well-being referrals. However, various challenges and limitations of the programme were identified, and recommendations were made for its future development. Therefore, whilst some of the findings were encouraging, further research into the implementation and impact of this and other such programmes is needed.

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