# Exercise as it relates to Disease/After School physical activity interventions for school children to prevent obesity

This is an analysis of the journal article "Effect of an After-School Intervention on Increases in Children’s Physical Activity" by Gortmaker et al. (2012)

## What is the background to this research?

The increasing prevalence of childhood obesity and its own set of related chronic conditions and disabilities, justify widespread action in prevention. 42 million children worldwide in 2013 were obese. The levels of childhood obesity worldwide can be attributed to a number of reasons including an increase in sedentary lifestyles, the consumption of high fat and sugar foods, and less sufficient physical activity (greater or equal to 60 minutes of moderate to vigorous physical activity every day). Studies have shown that once children develop high levels of adipose tissue within their bodies and become obese, that the likelihood of that child being obese in their adulthood is high.
15.2% of young children in Australia between the ages of 4–5 years old were estimated to be overweight and 5.5% were found to be obese in 2004. Whilst these figures have seemed to plateau in the last ten years, many other contributing factors such as socioeconomic status and language status have also been found to contribute to this enormous health epidemic; all of which can be prevented. Many studies have set out to investigate what the most effective methods are that countries can do to reduce overweight and obesity, as not only does obesity lead to terrible chronic conditions, disabilities and premature death, but it currently costs the world economy two trillion dollars a year and its estimated that almost half the population will be clinically overweight or obese by 2030.
The burden on health services and the economy to treat people for conditions linked to obesity is already at all time highs. Studies done such as the Gortmaker study, aim at “evaluat[ing] the effect of an after-school intervention on physical activity program changes and individual behaviour among children." Most leading causes to being overweight or obese are highly preventable, and Governments and health professionals need to find effective ways to reach and ultimately prevent entire populations of varying SEC and cultural/ethnic backgrounds to becoming obese.

## Where is the research from?

This research was conducted from 16 sites and 16 control sites within four YMCA associations in the Pacific Northwest, Midwest, South and Eastern United States of America. It was conducted by members of the Harvard School of Public Health, University of Minnesota School of Public Health, the YMCA of the USA and the department of Exercise and Health Sciences at the University of Massachusetts.

## What kind of research was this?

The research was a non random, quasi-experimental study and was assessed using pre intervention and follow up surveys, and accelerometers were used for measures of physical activity.

## What did the research involve?

The research involved implementing a physical activity program with all the children enrolled at all 16 YMCA sites and 16 control sites, where baseline data was collected to be used to compare to intervention data. The data collected was collected during implementation of the “Food and Fun After School” curriculum which helped YMCA programs operationalize the environmental standards for physical activity.
| Healthy Eating | Physical Activity | Advertising and screen time |
| Offer a fresh fruit or vegetable option every day in programs that are after school, three a day in all day holiday and vacation programs | Include moderate, fun, physical activity for every kid every day (30 minutes after school programs; 60 minutes holiday and vacation programs) and include out of doors activity whenever possible | Do not include commercial broadcast television or commercial movies in YMCA programs for children |
| Do not serve foods with trans fats | Offer vigorous, fun, physical activity as an option three times a week (20 minutes each time) | If included at all, limit computer time to less than one hour per day within YMCA programs for children |
| Involve kids in snack or meal preparation and clean up | Highly encourage staff to participate in physical activities with the kids | Review all posters, handouts and other materials used in YMCA programs for the children for advertising that may be incongruent with healthy eating and physical activity |
| Do not serve sugar sweetened drinks | | |
| Highly encourage staff to participate in all of these healthy eating outcomes with the children | | |
| Offer water as the primary drink every day | | |
The physical activity was measured using accelerometers which were handed out and were instructed to wear the accelerometers when the children got up in the morning to when they went to bed, and time where the accelerometer was not in use, this time was recorded in a log book by a parent. Data was collected in Spring and a follow up was conducted in the following Autumn.

## What were the basic results?

The basic results concluded that there was a greater level of physical activity in the intervention groups as opposed to the control groups in terms of minutes of average, moderate and vigorous physical activity.

## How did the researchers interpret the results?

Researchers interpreted the results positively as they believed it demonstrated the effectiveness of the intervention program in after school environments among youth. This was due to the interventions ability to generate an average energy expenditure difference of 25 kcals, representing a “substantial fraction” of the 100-165 kcal deficit the average American child. Therefore this leads to the increases in the relative weight gain. Adding the dietary guidelines, the researchers believe the program followed strictly would help significantly curb childhood obesity.

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

Conclusions from the research should be that the intervention program developed by the researchers proved to be significantly successful in generating energy expenditure in what was essentially 10 of the 60 recommended minutes of physical activity each day. This however should be taken into consideration with the varying limitations of the research which include the fact that the sample was quasi experimental rather than randomized, and that follow up data from the Spring to the following Autumn was at 52%. This followed by large staff turnover made the intervention difficult to maintain in its original form and the data collected from it limited. Nonetheless, the results look promising. With a more conscious decision to follow dietary guidelines and participate in physical activity in some form for the other 50 minutes outside the program, its impact on curbing childhood obesity could be incredibly positive.

## What are the implications of this research?

Despite the research’s limitations, the implications on childhood obesity and the subsequent health effects of such an intervention may have far-reaching consequences for government funded public health systems in the future, and individual health wellbeing for future generations.

## References

* 1 2 3 4 5 Gortmaker, S., Lee, R., Mozaffarian, R., Sobol, A., Nelson, T., Roth, B. and Wiecha, J. (2012). Effect of an After-School Intervention on Increases in Children’s Physical Activity. Medicine & Science in Sports & Exercise, 44(3), pp.450-457.
* 1 2 Who.int,. (2015). WHO | Obesity and overweight. Retrieved 20 September 2015, from http://www.who.int/mediacentre/factsheets/fs311/en/
* ↑ Rattray, B. (2015). Obesity and [Lack of] Physical Activity. Lecture, University of Canberra.
* ↑ Berenson, T. (2014). Report Says The Global Cost of Obesity Is $2 Trillion Annually. Time. Retrieved 10 September 2015, from http://time.com/3597407/obesity-global-cost-report/