School- and Family-Based Lifestyle Programme for Primary School Children in Punjab, Pakistan: A Feasibility Study

A School- and Family-Based Lifestyle Programme for Primary School Children in Punjab, Pakistan: A Feasibility Cluster Non-Randomised Controlled Trial

The goal of this feasibility study was to find out whether a larger trial of a school- and family-based lifestyle programme for primary school children in Punjab, Pakistan, can be carried out successfully. The programme aims to help children aged 7 to 11 years eat more healthily, be more physically active and sleep well, in order to prevent unhealthy weight gain.

The main questions it aimed to answer were:

• Will schools and families agree to take part, and will children stay in the study until the end?
• Can measurements and questionnaires be completed fully and within a reasonable time?
• Can the programme be delivered in schools as planned, and will children and parents attend the sessions?

Ten primary schools in three districts of Punjab (Lahore, Sahiwal and Bahawalnagar) took part. Children in five schools received the 17-week programme, and children in the other five schools continued their usual school routine.

Children in the programme schools:

• attended a weekly classroom session about healthy eating, physical activity and sleep
• took part in extra physical activity at school
• kept a weekly activity diary at home

Their parents were invited to group sessions and two individual meetings, and received printed guidance.

In all schools, children's height, weight, waist size and blood pressure were measured, and children and parents completed questionnaires at the start of the study and after 18 weeks.

Study Overview

• Status: Completed
• Conditions: Pediatric Obesity; Overweight , Obesity
• Intervention / Treatment: Behavioral: School- and family-based lifestyle programme

Detailed Description

This was a feasibility cluster non-randomised controlled trial. Schools were the unit of allocation: five of the seven schools able to timetable the programme in the spring term received the intervention, and five schools served as controls. To minimise contamination, schools in different groups were at least 3 km apart, served separate catchment areas and shared no teaching staff.

The programme was grounded in the socio-ecological model and targeted children (classroom education, school physical activity and self-monitoring), families (parent group sessions, individual meetings and printed guidance) and schools (daily physical activity opportunities). During Ramadan, school physical activity was suspended and session timing was adjusted.

The standard deviation of change and the intracluster correlation coefficient of BMI-for-age z-score (WHO 2007 reference) were estimated to inform the sample size of the definitive cluster randomised trial. Initial between-group differences in weight status, blood pressure and behaviours were estimated with linear mixed models including a random intercept for school, adjusted for baseline value, age, sex and district.

• Study Type: Interventional
• Enrollment (Actual): 1200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Bahāwalnagar, Pakistan
    • Participating primary schools, Lahore
  • Lahore, Pakistan
    • Participating primary schools, Lahore
  • Sāhīwāl, Pakistan
    • Participating primary schools, Sahiwal

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 7 years to 11 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Children enrolled in grades 3-5 (aged 7-11 years) in a participating primary school
• Written informed consent from a parent or legal guardian
• Verbal assent from the child

Exclusion Criteria:

• Physical disability or chronic condition limiting growth or physical activity, as reported by parents and confirmed by teachers
• Expected to change school before the 18-week follow-up

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lifestyle programme; Children in grades 3-5 and their parents in five primary schools received the 17-week school- and family-based lifestyle programme.	Behavioral: School- and family-based lifestyle programme; A 17-week programme with two components. Child component: 16 weekly 40-minute classroom sessions on healthy eating, physical activity and sleep, each followed by a take-home task; a target of 45 minutes of school physical activity (physical education, classroom activity breaks and after-class sport) on every school day; and weekly self-monitoring with a home exercise diary and self-weighing, with private feedback every four weeks. Parent component: nine 60-minute group sessions paralleling the child curriculum, two individual meetings on the child's growth and behaviour goals, and printed guidance on screen time, family activity, healthy eating and sleep. During Ramadan, school physical activity was suspended and session timing was adjusted.
No Intervention: Usual practice; Children in five primary schools continued their usual school timetable, including two 35-minute physical education periods per week, and received no study activities. Programme materials were provided to these schools after the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
School recruitment rate	Proportion of eligible primary schools that agreed to participate.	Baseline (before the programme started)
Child recruitment rate	Proportion of eligible children in grades 3-5 whose parents gave written consent.	Baseline (before the programme started)
Retention rate	Proportion of enrolled children followed up at 18 weeks.	18 weeks after baseline
Data completeness	Proportion of enrolled children (baseline) and followed-up children (18 weeks) with complete data for each measure: anthropometry, blood pressure, child questionnaire sections and parent questionnaire.	Baseline and 18 weeks
Time needed for data collection	Mean minutes per class required to complete the child questionnaire and to measure anthropometry and blood pressure.	Baseline and 18 weeks
Programme delivery and attendance	Proportion of planned child and parent sessions delivered; mean attendance (%) of children at classroom sessions and of parents at group sessions; frequency (days per week) and duration (minutes per day) of school physical activity.	During the 17-week programme
Standard deviation of change and intracluster correlation coefficient of BMI-for-age z-score	Parameters for the sample size calculation of the definitive trial. BMI-for-age z-score was calculated from measured height and weight using the WHO 2007 growth reference.	Baseline to 18 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in BMI-for-age z-score	Calculated from measured height and weight using the WHO 2007 growth reference.	Baseline to 18 weeks
Change in prevalence of overweight and obesity	Proportion of children with overweight (BMI-for-age z-score > +1 to +2) or obesity (z-score > +2) according to WHO 2007 cut-offs.	Baseline to 18 weeks
Change in waist circumference	Measured in centimetres midway between the lowest rib and the iliac crest.	Baseline to 18 weeks
Change in systolic and diastolic blood pressure	Measured in mmHg with a validated oscillometric device; classified using the American Academy of Pediatrics 2017 tables.	Baseline to 18 weeks
Change in physical activity score	Child-reported summary score (range 0-19) based on days with at least 60 minutes of activity, days walking or cycling to school, and days with physical education in the past 7 days; higher scores indicate more activity.	Baseline to 18 weeks
Change in diet score	Child-reported dietary questionnaire on intake of fruit and vegetables, sugar-sweetened beverages and fast food in the past 7 days.	Baseline to 18 weeks
Change in screen and sedentary time score	Child-reported score (range 0-8) from four items on screen and sedentary time, each scored 0-2 (<1 h, 1-2 h, >2 h per day); higher scores indicate more screen time.	Child-reported score (range 0-8) from four items on screen and sedentary time, each scored 0-2 (<1 h, 1-2 h, >2 h per day); higher scores indicate more screen time.
Change in sleep duration	Child-reported usual nightly sleep duration in hours.	Baseline to 18 weeks
Change in parental knowledge, attitudes and practices	Parent questionnaire scores for knowledge, attitudes and practices regarding childhood healthy weight, diet and physical activity.	Baseline to 18 weeks

Collaborators and Investigators

• Sponsor: Central South University
• Investigators: Principal Investigator: Qin Jiabi, Central South University

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2026
• Primary Completion (Actual): May 21, 2026
• Study Completion (Actual): May 21, 2026

Study Registration Dates

• First Submitted: November 6, 2026
• First Submitted That Met QC Criteria: November 6, 2026
• First Posted (Actual): November 12, 2026

Study Record Updates

• Last Update Posted (Actual): November 12, 2026
• Last Update Submitted That Met QC Criteria: November 6, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: School-based intervention; Physical activity; Feasibility study; Pakistan; Primary school children; Family-based intervention; Healthy diet; Cluster trial
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Overweight; Obesity; Pediatric Obesity; Motor Activity; Non-Medical Public and Private Facilities; Schools
• Other Study ID Numbers: XYGW-2026-18-FS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

De-identified individual participant data underlying the results reported in the publication will be shared with researchers who provide a methodologically sound proposal.

IPD Sharing Time Frame

Beginning after publication of the main results and for 5 years thereafter.

IPD Sharing Access Criteria

Requests should be directed to the corresponding author. Data will be shared after approval of a proposal and signature of a data-sharing agreement, subject to approval by the Institutional Review Board of the Xiangya School of Public Health, Central South University.

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No