Abstract
BackgroundSchool-based intervention studies promoting a healthy lifestyle have shown favorable immediate health effects. However, there is a striking paucity on long-term follow-ups. The aim of this study was therefore to assess the 3 yr-follow-up of a cluster-randomized controlled school-based physical activity program over nine month with beneficial immediate effects on body fat, aerobic fitness and physical activity.Methods and FindingsInitially, 28 classes from 15 elementary schools in Switzerland were grouped into an intervention (16 classes from 9 schools, n = 297 children) and a control arm (12 classes from 6 schools, n = 205 children) after stratification for grade (1st and 5th graders). Three years after the end of the multi-component physical activity program of nine months including daily physical education (i.e. two additional lessons per week on top of three regular lessons), short physical activity breaks during academic lessons, and daily physical activity homework, 289 (58%) participated in the follow-up. Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). After adjustment for grade, gender, baseline value and clustering within classes, children in the intervention arm compared with controls had a significantly higher average level of aerobic fitness at follow-up (0.373 z-score units [95%-CI: 0.157 to 0.59, p = 0.001] corresponding to a shift from the 50th to the 65th percentile between baseline and follow-up), while the immediate beneficial effects on the other primary outcomes were not sustained.ConclusionsApart from aerobic fitness, beneficial effects seen after one year were not maintained when the intervention was stopped. A continuous intervention seems necessary to maintain overall beneficial health effects as reached at the end of the intervention.Trial RegistrationControlledTrials.com ISRCTN15360785
Highlights
Clinical markers of chronic disease in adulthood like atherosclerosis, obesity and osteoporosis are due to lifelong processes that originate in childhood with physical inactivity and low aerobic fitness as key players in the high burden of chronic disease.[1]
Apart from aerobic fitness, beneficial effects seen after one year were not maintained when the intervention was stopped
Participation among groups was not different among the younger and older age group, but non-participation was much more common for the older age group irrespective of group (78% of the intervention group and 66% of the control group of non-participants were from the older age category)
Summary
Clinical markers of chronic disease in adulthood like atherosclerosis, obesity and osteoporosis are due to lifelong processes that originate in childhood with physical inactivity and low aerobic fitness as key players in the high burden of chronic disease.[1]. The importance of primary prevention by promoting physical activity in general[8] as well as in the scope childhood obesity has become indisputable,[9] as most pediatric obesity treatment interventions are marked by small changes in adiposity,[10] a substantial relapse rate and by a strong tracking of overweight into adulthood.[11] School-based intervention studies promoting a healthy lifestyle have shown favourable immediate health effects.[12] there is a striking paucity of information on long-term follow-up especially of high-quality randomised, controlled, theory driven trials that had shown efficacy at the end of their interventions.[12,13] we report the 3-year follow-up results of a cluster-randomised, controlled trial (‘‘Kinder- und Jugendsportstudie’’; KISS) comparing a school-based stringent physical activity program to traditional physical education during one school-year This trial has shown beneficial shortterm effects on aerobic fitness, physical activity, body fat and a composite cardiovascular risk factor score.[14]. The aim of this study was to assess the 3 yrfollow-up of a cluster-randomized controlled school-based physical activity program over nine month with beneficial immediate effects on body fat, aerobic fitness and physical activity
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