School-based physical activity programs for children and adolescents (aged 6 to 18 years): Evidence and implications for public health

Welcome! This work received support from KT Canada funding from the Canadian Institutes of Health

Research (CIHR)

School-based physical activity programs for children and adolescents (aged 6 to 18

years): Evidence and implications for public health

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The Health Evidence Team

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Review Dobbins, M., Husson, H., DeCorby, K., & LaRocca, R.L. (2013). School-based physical activity programs for promoting physical activity and fintess in children and adolescents aged 6-18. Cochrane Database of Systematic Reviews,2013(2), Art. No.: CD007651.

Importance of this Review

• Physical inactivity has been identified as the fourth leading risk factor for global mortality (WHO)

• 1 in 4 Canadian children and youth are either overweight or obese (PHAC)

• Schools settings are key for implementation of interventions that support healthy behaviours among children

Who has heard of a PICO(S)

question before?

1. Yes 2. No

Searchable Questions – Does it work Think “PICOS”

1. Population (situation)

2. Intervention (exposure)

3. Comparison (other group)

4. Outcomes

5. Setting

Summary Statement: Dobbins (2013)

P Children and adolescents aged 6 to 18 years I Strategies focused on the promotion of physical activity and

fitness including educational, health promotion, counseling, and management strategies

C Standard, currently existing physical education programs in schools

O primary outcomes: television viewing, physical activity rates, and physical activity duration; secondary outcomes: mean systolic/diastolic blood pressure, mean blood cholesterol level, body mass index (BMI), maximal Oxygen consumption (VO2max), and pulse rate

Quality Rating: 10 (strong)

Overall Considerations This review was based on 44 randomized controlled trials (RCTs),

with the majority of studies at moderate risk of bias. Intervention duration ranged from 12 weeks to 6 years.

School-based physical activity interventions had positive effects

on the duration of moderate to vigorous physical activity (MVPA), physical activity rates, television viewing, and VO2Max.

• No Effect was observed on the following physical health status measures: blood pressure, cholesterol, BMI, & pulse rate.

Printed education materials plus changes to the school

curriculum were present whenever statistically significant changes in duration of MVPA, physical activity rates, television viewing rates and V02Max were observed.

What’s the evidence - Outcomes reported in the review

Behavioural Outcomes(5 studies assessed physical activity rates; 23 studies assessed duration of physical activity; and 17 studies assessed time spent watching television )

Physical Health Status Related Outcomes (16 studies

assessed mean systolic blood pressure; 16 studies assessed mean diastolic blood pressure; 10 studies assessed mean blood cholesterol level; 32 studies assessed Body Mass Index (BMI); 6 studies assessed maximal Oxygen consumption (VO2max); and 6 studies assessed pulse rate)

What’s the evidence - Behavioural Outcome: Physical

Activity Rates

Physical Activity Rates (5 studies) • 2 of 5 studies, OR 2.74 (CI: 2.01-3.75), led to statistically

significant increase in physical activity rates among grade school children.

• Intervention components included: school curriculum changes, printed educational materials, community-based strategies, audio-visual materials, and play equipment.

What’s the evidence - Behavioural Outcome: Duration of

Physical Activity Duration of Physical Activity (23 Studies) • 12 of 17 studies led to statistically significant increases in

physical activity duration among grade school children (increases in duration ranged from approx. 5 min to 45 minutes more per week of MVPA, with CIs ranging from 1.4 min to approx. 90 min more per week of MVPA)

• Intervention components consistent across studies included:

changes to school curricula and printed educational materials.

What’s the evidence - Behavioural Outcome: Time Spent

Watching Television Time Spent Watching Television (17 studies) • 7 of 16 studies reported statistically significant effects on

television viewing (reduction in television viewing ranged from 5 min less per day to 60 min less per day).

• Intervention components consistent across studies included: changes to curricula, printed education materials, education sessions, and community-based strategies

What’s the evidence - Physical Health Status Related

Outcomes Maximal Oxygen Consumption (VO2max) (6 studies) • 4 of 6 studies reported statistically significant effects on VO2max

(ranging from 1.6 to 3.7mL/kg per min; 95% CI: 0.2 to 7.2 mL/kg per min) among grade school children.

No Impact observed on: blood pressure, cholesterol, body mass index, and pulse rate.

General Implications School-based interventions should be implemented, supported

and/or advocated for by the public health sector as a means to increase duration of MVPA, increase physical activity rates, improve V02Max, and reduce television viewing among children.

At a minimum, school based interventions should include printed

educational materials and curriculum changes that promote increased MVPA during school hours. Combining additional intervention components such as educational sessions, physical activity specific sessions and community-based initiatives, may have added benefit but requires further evaluation.

Interventions should be implemented for a minimum of 12 weeks.

Impact in the long term requires additional evaluation.

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