Cochrane review: School‐based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6‐18

Abstract

BackgroundThe World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease.ObjectivesThe purpose of this systematic review is to summarize the evidence of the effectiveness of school‐based interventions in promoting physical activity and fitness in children and adolescents.Search strategyThe search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.Selection criteriaTo be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group.Data collection and analysisStandardized tools were used by two independent reviewers to rate each study's methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured.Main results13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school‐based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally school‐based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects.Authors' conclusionsGiven that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time.Plain Language SummarySchool‐based interventions for promoting physical activity and fitness in children and adolescentsCurrent evidence suggests that school‐based physical activity interventions may be effective in the development of healthy lifestyle behaviours among children and adolescents that will then translate into reduced risk for many chronic diseases and cancers in adulthood. The evidence also suggests that the best primary strategy for improving the long‐term health of children and adolescents through exercise may be creating lifestyle patterns of regular physical activity that carry over to the adult years.It is estimated that as many at 1.9 million deaths worldwide are attributable to physical inactivity, and that inactivity is a key risk factor in the development of most chronic diseases and cancers.This is alarming particularly because it is known that physical activity patterns track from childhood into adulthood; that children are increasingly exhibiting risk factors for cardiovascular disease, such as obesity, elevated blood lipids, and hypertension, conditions which are known to track into adulthood; and that atherosclerotic fatty streaks in the coronary arteries, which are indicative of coronary heart disease, have been found postmortem in children.This review included 26 studies that evaluated the impact of combinations of school‐based interventions focused on increasing physical activity among children and adolescents. Participants were between the ages of 6 to18 living in Australia, South America, Europe and North America.There is good evidence that school‐based physical activity interventions are effective in increasing duration of physical activity, reducing blood cholesterol and time spent watching television and increasing VO2 max. VO2 max, known as maximal oxygen uptake or aerobic capacity, reflects the physical fitness level of an individual and generally increases as fitness levels improve. These interventions are not effective in increasing the percentage of children and adolescents who are physically active during leisure time, or in reducing systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects for four of the nine outcomes.

School-Based Youth Physical Activity Promotion: Thoughts and Beliefs of Pre-Service Physical Education Teachers

“…Participants in this study would therefore likely support interventions which involve influences from multiple parties. Second, parents and teachers (as identified by participants) have been common providers of past school-based physical activity promotion interventions (Dobbins et al, 2009). These findings also tap into a broader issue around the strategies for youth physical activity promotion, and the bodies that should be charged with facilitating such programs.…”

“…These included: the roles of physical education teachers (McDavid et al, 2012), supplementary school-based programs outside of the allocated curriculum (Beets, Beighle, Erwin, & Huberty, 2009), features of effective school-based programs (Dobbins et al, 2009), and attitudes toward potential involvement in supplementary school-based programs (McDavid et al, 2012). All customized survey questions were subjected to cognitive pre-testing methods, such as those used by Collins (2003).…”

“…Schools have become critical settings for health promotion strategies aimed at increasing youth physical activity due to distinct and unique methodological circumstances (Rachele, Cuddihy, Washington, & McPhail, 2013): the World Health Organization specifically identified schools as a target setting for the promotion of physical activity amongst youth (World Health Organization, 2004). Schools are an ideal setting for population-based physical activity measurement and interventions (Dobbins, DeCorby, Robeson, Husson, & Tirilis, 2009;Rachele, McPhail, Washington, & Cuddihy, 2012). They provide one of the few opportunities to address the full range of individuals in a population, and a last chance to access, at no extra cost, a captive audience.…”

“…It has been suggested that physical education teacher education programs in tertiary institutions, in addition to teaching physical education content and pedagogical skills, should be expanded to prepare future physical education teachers to develop natural linkages to physical activity and public health (Charles & Thomas, 2008;McKenzie & Kahan, 2004). A recent Cochrane review found that studies using physical education teachers as Australian Journal of Teacher Education Vol 41, 5, May 2016 54 the providers of interventions reported a significant effect, more often than those using general teachers to implement school-based physical activity interventions (Dobbins et al, 2009). In a recent study of 9 and 15 year-old Norwegian school children, physical activity specific teacher support was a significant predictor of physical activity during non-curricular school time (Ommundsen, Klasson-Heggebø, & Anderssen, 2006).…”

School physical education and its impact on the development of motoric performance and physical fitness of third grade pupils in primary school in Banská Bystrica in Slovakia

“…Školské prostredie sa považuje za najpriaznivejšie v realizácii rôznych pohybových programov zameraných na pozitívne ovplyvnenie úrovne pohybovej výkonnosti (Cavill, Biddle, & Sallis, 2001;Dobbins, DeCorby, Robeson, Husson, & Tirilis, 2009), ktoré si škola môže tiež sama vypracovať napríklad aj vo forme časovo-tematických plánov predmetu telesnej výchovy. Pohybový rozvoj a kvalitu vzdelá-vania v telesnej výchove súčasnej generácie ovplyvňujú rozličné činitele, ako sú kvalifikácia učiteľa TV, materiálne vybavenie školy, kurikulárne dokumenty (vzdelávacie programy, obsah vzdelávania a i.…”