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Abstract
BackgroundChildhood obesity and physical inactivity are increasing dramatically worldwide. Children of low socioeconomic status and/or children of migrant background are especially at risk. In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing. A special gap exists for younger children and in high risk groups.Methods/DesignThis paper describes the rationale, design, curriculum, and evaluation of a multicenter preschool randomized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons. Twenty preschool classes in the German (canton St. Gallen) and another 20 in the French (canton Vaud) part of Switzerland were separately selected and randomized to an intervention and a control arm by the use of opaque envelopes. The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behaviour, and to reduce media use. According to the ecological model, it included children, their parents and the teachers. The regular teachers performed the majority of the intervention and were supported by a local health promoter. The intervention included physical activity lessons, adaptation of the built infrastructure; promotion of regional extracurricular physical activity; playful lessons about nutrition, media use and sleep, funny homework cards and information materials for teachers and parents. It lasted one school year. Baseline and post-intervention evaluations were performed in both arms. Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test). Secondary outcomes included total (skinfolds, bioelectrical impedance) and central (waist circumference) body fat, motor abilities (obstacle course, static and dynamic balance), physical activity and sleep duration (accelerometry and questionnaires), nutritional behaviour and food intake, media use, quality of life and signs of hyperactivity (questionnaires), attention and spatial working memory ability (two validated tests). Researchers were blinded to group allocation.DiscussionThe purpose of this paper is to outline the design of a school-based multicenter cluster randomized, controlled trial aiming to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerland with a high migrant population.Trial RegistrationTrial Registration: clinicaltrials.gov NCT00674544
Highlights
Childhood obesity and physical inactivity are increasing dramatically worldwide
We developed a study to assess the effect of a multidisciplinary lifestyle intervention on BMI and aerobic fitness by focusing on a young age group and on children of migrant background (Ballabeina – Kinder im Gleichgewicht/enfants en équilibre)
Evaluation All evaluation measures were developed as defined in the CONSORT guidelines [79]
Summary
Childhood obesity and physical inactivity are increasing dramatically worldwide. Children of low socioeconomic status and/or children of migrant background are especially at risk. In Switzerland there is a prevalence of overweight and obesity of around 20% and 23% in 6- to 12-year old boys and girls [3]. The prevalence of overweight/obesity and of physical inactivity is especially increased in children of low socioeconomic status (SES) [4] and/or children of migrant background [5,6]. Obese children are at increased risk to become obese adults [7,8] and this tracking becomes stronger the closer the child gets to adult status [9]. Childhood obesity is already associated with cardiovascular disease risk factors [10,11,12,13] as well as other complications [7,8] and is an independent predictor of coronary heart disease in adulthood [14]
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