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Abstract
BackgroundEffective lifestyle interventions are needed to prevent noncommunicable diseases in low- and middle-income countries. We analyzed the effects of a school-based health promotion intervention on physical fitness after 28 months and explored if the effect varied with important school characteristics. We also assessed effects on screen time, physical activity and BMI.Methods and resultsWe performed a cluster-randomized pair matched trial in schools in urban Ecuador. The intervention included an individual and environmental component tailored to the local context and resources. Primary outcomes were physical fitness (EUROFIT battery), screen time (questionnaires) and physical activity (accelerometers). Change in BMI was a secondary outcome. A total of 1440 grade 8 and 9 adolescents (intervention: n = 700, 48.6%) and 20 schools (intervention: n = 10, 50%) participated. Data of 1083 adolescents (intervention: n = 550, 50.8%) from 20 schools were analyzed.The intervention increased vertical jump (mean effect 2.5 cm; 95% CI 0.8-4.2; P = 0.01). Marginally insignificant, adolescents from the intervention group needed less time for speed shuttle run (intervention effect = −0.8 s, 95% CI −1.58-0.07; P = 0.05). The proportion of students achieving over 60 minutes of moderate-to-vigorous physical activity/day decreased over time with the change in proportion significantly less in the intervention schools (6 vs. 18 percentage points, P < 0.01). The intervention effect on speed shuttle run was significant in larger schools while the effect on vertical jump was larger in mixed gender school compared to small and female schools. The proportion of schools that met the recommendations for physical activity increased with 37% in intervention schools with half-day schedule compared to the controls in the pair. No significant effects were found on screen time and BMI. Measurement of physical activity in a subsample was a limitation. No adverse effects were reported.ConclusionsA school-based intervention with an individual and environment component can improve physical fitness and can minimize the decline in physical activity levels from childhood into adolescence in urban Ecuador.Trial registrationClinicaltrials.gov identifier NCT01004367.
Highlights
Lifestyle related noncommunicable diseases (NCDs) are a leading cause of death in low- and middle-income countries (LMICs) [1]
Adolescence is an important period for the prevention of NCDs [7] as physical inactivity [8] and poor physical fitness [9] at early adolescence are associated with the development of NCDs during adulthood
We present the effectiveness of the trial on one set of the primary outcomes, i.e. physical fitness, screen time, physical activity and the effect on body mass index (BMI) as secondary outcome
Summary
Lifestyle related noncommunicable diseases (NCDs) are a leading cause of death in low- and middle-income countries (LMICs) [1] This is unfortunate, as they could be prevented by tackling risk factors such as physical inactivity [2], sedentary behavior (i.e. increased screen time) [3] and poor physical fitness [4]. The few school-based interventions from LMICs that aimed to promote an active lifestyle had important methodological limitations such as the absence of a theoretical framework to guide the interventions, a weak study design, or a lack of objectively measured outcomes [14] This is worrisome as adequate evidence is needed to guide allocation of scarce resources to tackle NCDs in LMICs [16]. We assessed effects on screen time, physical activity and BMI
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