Transform-Us! cluster RCT: 18-month and 30-month effects on children’s physical activity, sedentary time and cardiometabolic risk markers

Abstract

ObjectiveTo test the efficacy of theTransform-Us!school- and home-based intervention on children’s physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles.MethodsA 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (2010–2012), that used pedagogical and environmental strategies to reduce and break up SB, promote PA or a combined approach, compared with usual practice. Primary outcomes (accelerometry data; n=348) were assessed at baseline, 18 and 30 months. Secondary outcomes included body mass index (BMI) and waist circumference (WC) (n=564), blood pressure (BP) (n=537) and biomarkers (minimum n=206). Generalised linear mixed models estimated the interactive effects of the PA and SB interventions on the outcomes. If there was no interaction, the main effects were assessed.ResultsAt 18 months, there were intervention effects on children’s weekday SB (−27 min, 95% CI: −47.3 to −5.3) for the PA intervention, and on children’s average day PA (5.5 min, 95% CI: 0.1 to 10.8) for the SB intervention. At 30 months, there was an intervention effect for children’s average day SB (−33.3 min, 95% CI: −50.6 and −16.0) for the SB intervention. Children’s BMI (PA and SB groups) and systolic BP (combined group) were lower, and diastolic BP (PA group) was higher. There were positive effects on WC at both time points (SB intervention) and mixed effects on blood parameters.ConclusionsTheTransform-Us!PA and SB interventions show promise as a pragmatic approach for reducing children’s SB and adiposity indicators; but achieving substantial increases in PA remains challenging.Trial registrationISRCTN83725066; ACTRN12609000715279.

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention

“…In school-aged children, interventions taking a rather innovative approach have been conducted, such as school-based gardening, 93 gamification strategy to nutrition and physical activity, 94 or interventions delivered by class-room teachers. 95 However, only few studies conducted in school-aged children have found intervention effects (for example, other works [94][95][96] ), and the majority of studies have shown no effects of the intervention (for example, previous studies 93,[97][98][99][100][101][102][103] ).…”

Scaling up a school-based intervention to increase physical activity and reduce sedentary behaviour in children: protocol for theTransformUshybrid effectiveness–implementation trial

“…The results of this RCT are described and interpreted in detail elsewhere. 26 However, in brief, at 18 months (n=348), compared with usual practice, children who received the physical activity intervention (groups PA-I and PA+SB-I) had significantly less weekday sedentary time (−27 min/day). Compared with usual practice, children who received the sedentary behaviour intervention (SB-I and PA+SB-I) spent more time in daily physical activity (5.5 min/day) at 18 months, and at 30 months spent 33 min less in daily sedentary time, and specifically, 63 min less in sedentary time on weekdays, with no differences in physical activity at 30 months.…”

“…The efficacy of the initial TransformUs programme was demonstrated in a four-arm two-by-two factorial design cluster-randomised controlled trial (RCT) involving 20 primary (elementary) schools, 226 teachers and over 1600 children in Melbourne, Australia (2010–2013). 26 The three intervention arms targeted either increases in physical activity (PA-I), reductions in sedentary behaviour (SB-I) or a combination of both (PA+SB-I), compared with a usual practice control. The results of this RCT are described and interpreted in detail elsewhere.…”

“…Compared with usual practice, children who received the sedentary behaviour intervention (SB-I and PA+SB-I) spent more time in daily physical activity (5.5 min/day) at 18 months, and at 30 months spent 33 min less in daily sedentary time, and specifically, 63 min less in sedentary time on weekdays, with no differences in physical activity at 30 months. 26 Thus, strategies to promote both children’s physical activity and reduce sedentary behaviour were important. Results also showed beneficial effects on children’s adiposity markers (body mass index (BMI) and waist circumference (n=564)).…”

“…However, there were mixed effects on children’s blood pressure (BP), positive effects on systolic BP and negative effects on diastolic BP (n=537) and in a subsample of children (n=206), on blood parameters (eg, negative effects on some inflammatory markers such as C reactive protein, interleukin (IL)-6, IL-2 and tumour necrosis factor-α, beneficial effects on vitamin D, brain-derived neurotrophic factor and plasminogen activator inhibitor-1). 26 …”