The “11 for Health in Denmark” intervention in 10‐ to 12‐year‐old Danish girls and boys and its effects on well‐being—A large‐scale cluster RCT

Abstract

Background The present study investigates the well‐being effects for 10‐ to 12‐year‐old children who participated in the school‐based intervention “11 for Health in Denmark,” which comprises physical activity (PA) and health education. Subgroup analyses were carried out for boys and girls. Method Three thousand sixty‐one children were randomly assigned to an intervention group (IG) or a control group (CG) by 5:1 cluster randomization by school. 2533 children (mean age 11.5 ± 0.4; 49.7% boys) were assigned to IG and 528 children (mean age 11.4 ± 0.5; 50.8% boys) were assigned to CG. IG participated in the “11 for Health in Denmark” 11‐week program, consisting of 2 × 45 min per week of football drills, small‐sided games, and health education. CG did not participate in any intervention and continued with their regular education. Before and after the intervention period, both groups answered a shortened version of the multidimensional well‐being questionnaire KIDSCREEN‐27. Results The “11 for Health in Denmark” intervention program had a positive effect on physical well‐being in girls (IG: 48.6 ± 8.5 to 50.2 ± 9.3), whereas the improvement was not significant in boys. The program also had a positive impact on well‐being scores for peers and social support (IG: 50.2 ± 10.2 to 50.8 ± 10.1), though when analyzed separately in the subgroups of boys and girls the changes were not significant. No between‐group differences were found for psychological well‐being or school environment. Conclusion The intervention program had a positive between‐group effect on physical well‐being in girls, whereas the change was not significant in boys. The overall scores for peers and social support improved during the intervention period, but no subgroup differences were found.

The Danish “11 for Health” program raises health knowledge, well‐being, and fitness in ethnic minority 10‐ to 12‐year‐olds

“…The “11 for Health in Denmark” large‐scale cluster‐randomized controlled trial provides a rare insight into an under researched group of schoolchildren with an ethnic minority background, who face more health‐related challenges than their peers and show markedly different physical activity patterns. This study investigated whether a large‐scale physical activity study affects ethnic minority to the same degree as ethnic majority schoolchildren 10,31‐34 . We hypothesized that the participants enrolled in the “11 for Health in Denmark,” both girls and boys, would perceive the program as enjoyable.…”

Implementation facilitation of the “11 for Health in Denmark”: A case study in a Danish 5th grade class

“…To strengthen this argument, "11 for Health" has been proven to provide effects on body composition, blood pressure, cardiovascular fitness, health knowledge, cognitive performance, well-being, and enjoyment. 11,12,49,10,13,15 However, as we found the teacher to be a key factor in the implementation facilitation, we recommend that teachers apply AST when using the "11 for Health" concept. This means, among other things taking the schoolchild's perspective, vitalizing potential inner motivational resources; providing an explanatory rationale for the activities and drills; acknowledging and accepting negative effects during teaching; relying on and supporting informational and non-pressuring language; and displaying patience when experiencing frustrated schoolchildren during teaching.…”

Translation and content validation of the trans-contextual model questionnaire battery and development of a web-based version for 10-to 12-year-old Danish schoolchildren

“…Similar to previous questionnaire research applied to the 11 for Health concept, the use of the translated TCM questionnaire is planned as a web-based questionnaire (Larsen et al, 2021;Madsen et al, 2020;Ørntoft et al, 2018). However, web-based administration may yield slightly different results compared to paper-based versions as the web-based administration is seldomly done in a controlled setting (Austin et al, 2006;Donker et al, 2010).…”

“…However, only 26% of Danish children between 11 and 15 years of age conform to national guidelines of 60 min/day of moderate-to-high PA (Toftager & Brønd, 2019). Studies show that participation in informal and particularly formal leisure-time sports is effective in promoting PA and increases the chances of conforming to WHO guidelines (Madsen et al, 2020;Ørntoft et al, 2018). The evidence-based 11 for health-in Denmark concept (hereafter 11 for Health) targeting 10-to 12-yearold fifth-grade schoolchildren has been successful in increasing physical fitness, cognition, well-being, health knowledge and enjoyment (Larsen et al, 2021;Lind et al, 2018;Madsen et al, 2020;Ørntoft et al, 2018).…”

“…Studies show that participation in informal and particularly formal leisure-time sports is effective in promoting PA and increases the chances of conforming to WHO guidelines (Madsen et al, 2020;Ørntoft et al, 2018). The evidence-based 11 for health-in Denmark concept (hereafter 11 for Health) targeting 10-to 12-yearold fifth-grade schoolchildren has been successful in increasing physical fitness, cognition, well-being, health knowledge and enjoyment (Larsen et al, 2021;Lind et al, 2018;Madsen et al, 2020;Ørntoft et al, 2018). However, a key element in the successful application of the 11 for Health concept has not been examined, namely the motivational processes underlying participation and the behavioural changes the program can potentially bring about.…”