"11 for Health" in Pakistan - Effects on Physical Fitness, Health Knowledge and Well-being of 8-14-year-old Schoolchildren

April 17, 2026 updated by: Farman Ullah

"11 for Health" in Pakistan - Effects of a School-Based Football Intervention Programme on Cardiorespiratory Health, Physical Fitness, Health Knowledge and Well-being of 8-14-year-old Schoolchildren

This study examined the effects of a school-based football intervention, the "11 for Health" (11fH) programme, on cardiorespiratory health, musculoskeletal fitness, health knowledge and well-being among Pakistani school children.

The main questions it aimed to answer were:

  • Does the programme enhance Pakistani schoolchildren's cardiorespiratory health and physical fitness, including blood pressure, resting heart rate, aerobic capacity, horizontal jumping ability, agility, 30-m sprint, postural balance, BMI and waist circumference?
  • Does it improve their health knowledge and well-being?

Researchers compared students who participated in the "11 for Health" intervention to those who continued their regular school curriculum. 254 fifth- and sixth-grade students (126 boys, 128 girls) from five schools in Islamabad participated in this study, allocated to an 11-week intervention group, a 5-week intervention group, and a control group.

Researchers tested all groups before and after the intervention. Cardiorespiratory health and physical fitness were assessed with standardized tests. Health knowledge and well-being were measured with validated Urdu questionnaires.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

In developing countries like Pakistan, limited funding, infrastructure, and policy support pose challenges for promoting structured physical activity among school-aged children. These gaps result in low physical activity levels, with consequences extending beyond individual health to national healthcare systems and societal well-being.

Despite growing interest in improving physical education in Pakistan, current initiatives remain fragmented and under-researched. Introducing a structured, football-based physical and health education model such as "11 for Health" into this context offers an opportunity to test a scalable and contextually relevant approach.

The "11 for Health" programme is designed to deliver health education through physical activity using football drills and small-sided games. The intervention comprises 90 minutes of football-related activities per week, integrated with the delivery of ten health messages addressing communicable and non-communicable diseases (NCDs). Each health message is thematically linked to a specific football skill (Fuller et al. 2017). Since its in inception in South Africa in 2009, the "11 for Health" programme has been implemented across multiple regions, including Africa, South America, Oceania, Europe, and Southeast Asia, and a growing body of literature has analysed its effects on physical fitness, health knowledge, well-being, and cognitive outcomes. Its documented effectiveness in a range of international settings suggests potential for positive impact in Pakistan as well.

This study examined the "11 for Health" programme within the public school system and evaluated its effects on multiple aspects of health and well-being. These findings could help determine the programme's adaptability, thereby contributing critical insights into sustainable strategies for promoting health and physical fitness among Pakistani schoolchildren.

Study Type

Interventional

Enrollment (Actual)

254

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
      • Islamabad, Pakistan
        • Khursheed Hockey Ground, F-10/1, Islamabad

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Enrollment in Grade 5 or Grade 6 in the participating schools during the 2023 to 2024 academic year
  • Provision of written informed consent from parents or guardians together with assent from the students

Exclusion Criteria:

  • Inability to provide consent or assent and medical conditions that prevented participation in football or other moderate-to-vigorous physical activities. Examples included severe mobility limitations, serious cardiovascular disease, or severe asthma.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 11-week Intervention Group
The 11-week Intervention Group participated in the complete "11 for Health" program for 11 weeks.
Other: "11 for Health" Intervention Programme
The "11 for Health" intervention consisted of two 45-minute sessions per week for 11 weeks, including a "Play Football" session that focused on developing specific football skills, and a "Play Fair" session that delivered health education through football-related activities, replacing traditional chalkboard instruction. Small-sided games (3v3, 4v4) were included in every session as the main physical stimulus.
Experimental: 5-week Intervention Group
The 5-week Intervention Group completed the last 5-week intervention program after returning school (the new semester began).
Other: "11 for Health" Intervention Programme
The "11 for Health" intervention consisted of two 45-minute sessions per week for 11 weeks, including a "Play Football" session that focused on developing specific football skills, and a "Play Fair" session that delivered health education through football-related activities, replacing traditional chalkboard instruction. Small-sided games (3v3, 4v4) were included in every session as the main physical stimulus.
No Intervention: Control Group
The control group continued with their regular daily life and school activities.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Resting Heart Rate
Time Frame: before and at the end of the 11-week intervention

Resting heart rate (RHR) was measured four times using a portable liquid crystal display (LCD) finger-type pulse oximeter. Prior to RHR measurement, participants were required to rest in a seated position for 15-20 minutes. Four measurements were taken for each participant, with at least 2-minute intervals between readings.

Unit of Measurement: Beats per minute (bpm)
before and at the end of the 11-week intervention
Systolic Blood Pressure and Diastolic Blood Pressure
Time Frame: before and at the end of the 11-week intervention

Trained staff measured blood pressure using an aneroid sphygmomanometer. The first and fifth Korotkoff sounds were recorded as systolic (SBP) and diastolic (DBP) pressure. Participants rested seated for 15-20 minutes beforehand. Four readings were taken at intervals of at least two minutes.

Unit of Measurement: Millimeters of Mercury (mmHg)
before and at the end of the 11-week intervention
Body Mass Index (BMI)
Time Frame: before and at the end of the 11-week intervention

Weight and Height were combined to report BMI in kg/m^2. Height was measured to the nearest 0.1 cm using a yardstick. Weight was recorded with a 0.1 kg precision using a portable calibrated scale. These measurements were conducted with participants barefoot and wearing light clothing.

Unit of Measurement: BMI in kg/m^2
before and at the end of the 11-week intervention
Waist Circumference
Time Frame: before and at the end of the 11-week intervention

Waist circumference (WC) was assessed at the midpoint between the lowest rib and the superior border of the iliac crest at the end of normal expiration, using a non-stretch measuring tape held parallel to the floor.

Unit of Measurement: centimetre (cm) for the waist circumference
before and at the end of the 11-week intervention
Postural Balance
Time Frame: before and at the end of the 11-week intervention

Postural balance was assessed using the Stork balance stand test. Participants placed their hands on hips, positioned one foot against the supporting leg's knee, and raised the supporting heel to balance on the ball of the foot. Timing began at heel lift and stopped if hands moved, the foot shifted, knee contact broke, or the heel touched down.

Unit of Measurement: seconds (s)
before and at the end of the 11-week intervention
Jump Performance
Time Frame: before and at the end of the 11-week intervention

Jump performance was assessed by standing long jump test. Each student performed two barefoot jumps. Starting with toes behind a line, feet parallel and shoulder-width apart, they squatted to 90° knee flexion with hands on hips. After two seconds, they jumped forward, keeping hands on hips.

Unit of Measurement: Distance from line to heel was measured to the nearest centimetre (cm).
before and at the end of the 11-week intervention
Agility
Time Frame: before and at the end of the 11-week intervention

The Arrow-head agility test is used to measure agility. Participants sprint from a start line to a middle cone, turn right around a side cone, circle the farthest cone, and return. Knocking over a cone requires a restart. Two attempts were made after one trial. The shorter time of the two attempts was recorded.

Unit of Measurement: Seconds (s) - Time to complete the test
before and at the end of the 11-week intervention
30-metre Sprint
Time Frame: before and at the end of the 11-week intervention

The participants performed two 30-metre sprints at their maximal speed with 2-3 minutes of rest between attempts. Three timers with stopwatches stood 6 metres perpendicular to the finish line. They started timing at the student's first movement and stopped when the upper body crossed the finish line.

Unit of Measurement: The average time in seconds (s) given by testers.
before and at the end of the 11-week intervention
Cardiovascular Performance
Time Frame: before and at the end of the 11-week intervention

Cardiovascular performance was evaluated with the Yo-Yo intermittent recovery level 1 children's test. The test took place outdoors at all schools. It consisted of repeated 16-metre shuttle runs with progressively increasing speed. Between runs, participants had a 10 second active recovery by jogging around a cone set 4 metres behind the start line. A prerecorded beep regulated the pace. Missing the beep twice terminated the test.

Unit of Measurement: Total running distance in metres (m)
before and at the end of the 11-week intervention
Health Knowledge
Time Frame: before and at the end of the 11-week intervention

A 34-item Urdu version health knowledge questionnaire assessed children's understanding of ten health topics related to the "11 for Health" programme before and after the intervention. Items used either a true/false/don't know format or multiple choice with four options. Correct answers received a score of 2, while incorrect or don't know responses scored 1.

Unit of Measurement: Mean percentage and standard deviation of correct responses were calculated for each health message based on all individual answers.
before and at the end of the 11-week intervention
Well-being
Time Frame: before and at the end of the 11-week intervention
An Urdu version of the adapted KIDSCREEN-27 questionnaire was used to measure well-being of the partcipants. The 20 items covered four dimensions: physical well-being, psychological well-being, peers and social support, and school environment. Items used a five-point Likert scale ranging from "never" to "always" or "not at all" to "extremely". The subscale scores are converted to a standardized scale where the average is around 50 and the standard deviation is about 10. Higher scores reflected better well-being.
before and at the end of the 11-week intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Farman Ullah

Collaborators

University of Southern Denmark

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 13, 2024

Primary Completion (Actual)

December 20, 2024

Study Completion (Actual)

December 20, 2024

Study Registration Dates

First Submitted

April 12, 2026

First Submitted That Met QC Criteria

April 17, 2026

First Posted (Actual)

April 21, 2026

Study Record Updates

Last Update Posted (Actual)

April 21, 2026

Last Update Submitted That Met QC Criteria

April 17, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Reg. No. HPESS 007

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Measurements: Data obtained from physical fitness tests (YYIR1C, standing long jump, arrowhead agility test, 30-metre sprint, Stork balance test), cardiorespiratory health measurements (e.g. BP, RHR), health knowledge and well-being assessments will be shared.

Data Anonymization: All shared data will be fully anonymized to ensure participant confidentiality. Personal identifiers such as names, birth dates, and schools will be removed. Data will be reviewed and aggregated where necessary to prevent the possibility of participant re-identification.

Data Format: The data will be provided in standardized file formats such as Excel (.xlsx) to support compatibility and ease of use in secondary analyses.

Access Control: Access to the shared IPD will be granted to qualified researchers who provide a valid research proposal, informed consent form(s) and agree to comply with data use agreements that ensure the data will be used solely for research purposes and not for commercial gain.

IPD Sharing Time Frame

Beginning 1 year after publication with no end date.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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