# Exercise as it relates to Disease/The effectiveness of a school-based physical activity intervention on childhood overweight and obesity

The following Wikibooks page is a critical analysis and factsheet for the journal article "Does school-based physical activity decrease overweight and obesity in children aged 6-9 years? A two-year non-randomized longitudinal intervention study in the Czech Republic" by Sigmund, Ansari and Sigmundova (2012)
This has been created by U3132147

## What is the background of this research?

The shocking increase in overweight and obese school aged children has become a global concern. In recent years, measures have been employed in many schools across the world to increase the amount of physical activity (PA) and decrease sedentary behavior in children during school hours and over the weekend.
Furthermore longitudinal studies of PA programs implemented in schools are few across eastern European countries providing a gap in the knowledge and understanding of the level of PA being performed by school-aged children and its link to the prevalence of overweight and obesity in these countries.
The objectives of the study were to explore and compare PA levels in school aged children during school hours and over the weekend. Populations of overweight and obese children in schools were compared to see the effect of intervention programs and PA.

## Where is the research from?

The research was conducted in four schools across the Czech Republic. Selection criteria for the intervention and control schools was based on participation in the regional "Healthy Schools" project, developed by the World Health Organisation (WHO) for Europe. The two intervention schools participate in the project, whereas the two control schools have no involvement. The study was supported by the University of Olomouc (Czech Republic) in which two of the authors (Erik Sigmund and Dagmar Sigmundova) are employed, potentially creating a bias in the research. The authors share professional interest in sports science, PA, primary education, health and childhood obesity.

## What kind of research was this?

The study was undertaken as a non-randomized, two-year school-based program. Earlier intervention studies of this kind similarly run over a one to three year course, providing data from students throughout school terms. Longitudinal studies although valuable, prove difficult in ascertaining both validity and reliability. Commonly, research in this area can be read in meta-analysis articles spanning several studies directed over short-term periods to give a snapshot of the health trends throughout the years discussed.

## What did the research involve?

The subjects included 43 girls and 45 boys (intervention) and 41 girls and 47 boys (control) all aged between six and nine years (± 0.5 years).
A standard PA program was implemented in each of the four schools comprising of two 45 minute physical education lesson per week. In addition to this, intervention schools were encouraged to participate in further PA during recess breaks (20 minutes), short breaks (3–5 minutes) and after school care (40–90 minutes); a total of an extra two hours and five minutes of possible PA time per day.
Monitoring of PA was collected through continuous accelerometer and pedometer readings and logged in a tracking book for each child. Data was quantified through variable activity energy expenditure (AEE) in order to gain calculated levels of energy expenditure taking into consideration the child's age, height, weight and gender. The equipment used to measure the PA of the children had been validated through high-internal group reliability measures shown in similar studies.
It is noted in the article, that the control schools, as well as not participating in the WHO "Healthy Schools" project were also disadvantaged with less space in which PA could be conducted, additionally, PA was not a primary focus during after-school care. This may be accepted as a limitation of the study where environmental opportunities play a major role in the cause and outcome of childhood overweight and obesity in these particular control schools. It should also be recognised that data measures were taken by different adults depending on the child's location at the time of collection, potentially affecting the reliability of the logging.

## What were the basic results?

Significant measures found that intervention groups displayed a reduction in the proportion of overweight and obese children during the second year of the program. Surprisingly, it was also found that overweight and obese proportions increased in control groups over the course of the study.
Table 2: Percentage of obese student populations within intervention and control groups September 2006, September 2007 and September 2009 of the intervention study.
| Time | Intervention Girls | Control Girls | Intervention Boys | Control Boys |
| Pre-Intervention | 7% | 7% | 11% | 6% |
| During | 2% | 12% | 0% | 17% |
| Post-Intervention | 0% | 22% | 0% | 23% |
More specifically, measures revealed higher step counts and AEE during school hours for intervention groups compared to control groups (p<0.0001). Weekend measures exposed lower step count and AEE compared to school days for both the intervention and control groups, however, the intervention proved beneficial with intervention children participating in an overall higher level of PA compared to their control counterparts (p<0.0001).
It is acknowledged in the article that although the intervention evidenced significant improvement in the proportion of overweight and obese in school aged children, the data collected revealed that international levels of PA recommendations were not met by the intervention or control group children throughout the study.

## How did the researchers interpret the results?

School based PA intervention is beneficial in reducing the proportion of overweight and obese in children aged six to nine years. Shortcomings regarding the failure of the intervention results to meet international PA recommendations are attributed to inadequate travelling distances to schools, homework and study hours, as well as the absence of monitoring of nutritional habits throughout the study.

## What conclusions can be taken away from this research?

The results of the study imply that PA intervention in schools plays an important role in the prevention of overweight and obesity in school-aged children, however it should be recognised that PA is not the only component of health and being physically fit. There is plenty of opportunity for schools to implement changes and encourage activity and movement throughout school days, and over the weekend. The importance of teaching children a healthy lifestyle goes beyond PA, and it is vital during these early stages of life.

## What are the implications of this research?

PA should be encouraged in young children on a daily basis, the importance of providing PA conducive environments for school-aged children is vital in ensuring opportunities and support for a healthy lifestyle. Without doubt numerous factors take part in the development of healthy living, however it is during these younger years, that children can be introduced to the importance of making healthy decisions. Overweight and obese populations in young children is a worldwide issue, but it shouldn't be.

## Further reading

For more information regarding topics discussed in the research article the following websites or articles may be of interest:
1. The World Health Organisation for Europe website
* Child and adolescent health
2. Earlier longitudinal research in the Czech Republic
* Changes in physical activity in pre-schoolers and first-grade children

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Sigmund, E., El Ansari, W., Sigmundova, D. (2012), Does school-based physical activity decrease overweight and obesity in children aged 6-9 years? A two-year non-randomized longitudinal intervention study in the Czech Republic. BMC Public Health, 12 (570): 1471-2458
* 1 2 3 WHO Regional Office for Europe (2016). Child and adolescent health [Health topics > Life stages]. Retrieved from World Health Organisation website: http://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health.
* ↑ Madisch, I., Hofmayer, S. (2016) Research Gate [GmbH]. Retrieved from Research Gate website:https://www.researchgate.net/
* ↑ Verstraete, S.J.M, Cardon, G.M., De Clercq, D.L.R., De Bourdeaughuij, I.M.M. (2007) A comprehensive physical activity promotion programme at elementary school: The effects on physical activity, physical fitness and psychosocial correlates of physical activity. Pub Health Nutr, 10:477-484.
* ↑ Griew, P. Page, T. Thomas, S. Hillsdon, M. Cooper, A.R. (2010). The school effect on children's school time physical activity: the PEACH project. Prev Med, 51:282-286.
* ↑ Ridgers, N.D. Stratton, G. (2010) Twelve-month effects of a playground intervention on children's morning and lunchtime recess physical activity levels. J Phys Act Health, 7:167-175
* ↑ Street, C.T., Ward, K.W. (2012). Improving validity and reliability in longitudinal case study timelines. European Journal of Information Systems, 21: 160-175.
* ↑ Apfelbacher, C.J., Cairns, J., Brucker, T., Mohrenschlager, M., Behrendt, H., Ring,J., Kramer, U. (2008). Prevalence of overweight and obesity in East and West German Children in the decade after reunification: population-based series of cross-sectional studies. J Epidemiol Commnunity Health, 62:125-130.
* ↑ Stamatakis, E., Zaninotto, P., Falaschnetti, E., Mindel, J., Head, J. (2010). Time trends in childhood and adolescent obesity in England from 1995 to 2007 and projections or prevalence to 2015. J Epidemiol Community Health, 64:167-174.
* ↑ Sigmundova, D., El Ansari, W., Sigmund, E., Fromel, K. (2011). Secular trends: A ten-year comparison of the amount and type of physical activity and inactivity of random samples of adolescents in the Czech Republic. BMC Public Health, 11:731.
* 1 2 Gonzalez-Suarez, C., Worley, A., Grimmer-Somers, K., Dones, V. (2009). School-based interventions on childhood obesity: A meta-analysis. Am J Prev Med, 37:418-427.
* ↑ Sallis, J.F., Buono, M.J., Roby, J.J., Carlson, D., Nelson, J.A. (1990). The Caltrac accelerometer as a physical activity monitor for school-aged children. Med Sci Sports Exerc, 22:698-703.
* ↑ Bray, M.S., Morrow, J.R.J., Pivarnik, J.M., Bricker, J.T. (1992). Caltrac validity for estimating caloric expenditure with children. Pediatr Exerc Sci, 4:166-179.
* ↑ Sigmund, E., Singmundova, D., El Ansari, W. (2009). Changes in physical activity in pre-schoolers and first-grade children: Longitudinal study in the Czech Republic. Child Care Health Dev, 35(3),376-382.