School-Based Intervention Programs for Preventing Obesity and Promoting Physical Activity and Fitness: A Systematic Review

Hidayet Suha Yuksel, Fatma Neşe Şahin, Nebojsa Maksimovic, Patrik Drid, Antonino Bianco, Hidayet Suha Yuksel, Fatma Neşe Şahin, Nebojsa Maksimovic, Patrik Drid, Antonino Bianco

Abstract

With the significant decrease in physical activity rates, the importance of intervention programs in the schools, where children spend a significant part of the day, has become indisputable. The purpose of this review is to systematically examine the possibility of school-based interventions on promoting physical activity and physical fitness as well as preventing obesity. A systematic approach adopting PRISMA statement was implemented in this study. Three different databases (2010-2019) were screened and primary and secondary school-based intervention programs measuring at least one variable of obesity, physical activity, or physical fitness were included. The risk of bias was assessed using the validated quality assessment tool for quantitative studies. Among 395 potentially related studies, 19 studies were found to meet the eligibility criteria. A general look at the studies examined reveals that among the outcomes, of which most (18/19) were examined, a significant improvement was provided in at least one of them. When the program details are examined, it can be said that the success rate of the physical activity-oriented programs is higher in all variables. School-based interventions can have important potential for obesity prevention and promotion of physical activity and fitness if they focus more on the content, quality, duration and priority of the physical activity.

Keywords: health promotion; intervention; obesity; physical activity; physical activity promotion; physical fitness; school; sedentary behavior.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
General framework of the systematic review. PA: Physical activity.
Figure 2
Figure 2
Flow diagram of studies through the review process.

References

    1. Chaddha A., Jackson E.A., Richardson C.R., Franklin B.A. Technology to Help Promote Physical Activity. Am. J. Cardiol. 2017;119:149–152. doi: 10.1016/j.amjcard.2016.09.025.
    1. Ogden C.L., Carroll M.D., Curtin L.R., McDowell M.A., Tabak C.J., Flegal K.M. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–1555. doi: 10.1001/jama.295.13.1549.
    1. Janssen I., Leblanc A.G. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int. J. Behav. Nutr. Phys. Act. 2010;7:40. doi: 10.1186/1479-5868-7-40.
    1. Lonsdale C., Rosenkranz R.R., Peralta L.R., Bennie A., Fahey P., Lubans D.R. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Prev. Med. 2013;56:152–161. doi: 10.1016/j.ypmed.2012.12.004.
    1. Varghese T., Schultz W.M., McCue A.A., Lambert C.T., Sandesara P.B., Eapen D.J., Gordon N.F., Franklin B.A., Sperling L.S. Physical activity in the prevention of coronary heart disease: Implications for the clinician. Heart. 2016;102:904–909. doi: 10.1136/heartjnl-2015-308773.
    1. WHO . Global Recommendations on Physical Activity for Health. WHO Press; Geneva, Switzerland: 2010.
    1. Knuth A.G., Hallal P.C. Temporal trends in physical activity: A systematic review. J. Phys. Act. Health. 2009;6:548–559. doi: 10.1123/jpah.6.5.548.
    1. Ortega F., Ruiz J., Castillo M., Sjöström M. Physical fitness in childhood and adolescence: A powerful marker of health. Int. J. Obes. 2008;32:1. doi: 10.1038/sj.ijo.0803774.
    1. Green K. Understanding Physical Education. Sage; London, UK: 2008.
    1. To Q.G., Wharton L., Gallegos D., Stylianou M., Do D.V., To K.G., Tran H.T.M., Trost S.G. School-based physical education: Physical activity and implementation barriers in Vietnamese elementary schools. Eur. Phys. Educ. Rev. 2019 doi: 10.1177/1356336X19878746.
    1. Morgan P., Bourke S. Non-specialist teachers’ confidence to teach PE: The nature and influence of personal school experiences in PE. Phys. Educ. Sport Pedagog. 2008;13:1–29. doi: 10.1080/17408980701345550.
    1. Slusser W. Family physicians and the childhood obesity epidemic. Am. Fam. Physician. 2008;78:34–37.
    1. WHO Global Strategy on Diet, Physical Activity and Health. [(accessed on 15 September 2019)]; Available online:
    1. WHO Obesity and Overweight. [(accessed on 10 September 2019)]; Available online: .
    1. Hardy L.L., King L., Espinel P., Okely A.D., Bauman A. Methods of the NSW Schools Physical Activity and Nutrition Survey 2010 (SPANS 2010) J. Sci. Med. Sport. 2011;14:390–396. doi: 10.1016/j.jsams.2011.03.003.
    1. Swinburn B.A., Sacks G., Hall K.D., McPherson K., Finegood D.T., Moodie M.L., Gortmaker S.L. The global obesity pandemic: Shaped by global drivers and local environments. Lancet. 2011;378:804–814. doi: 10.1016/S0140-6736(11)60813-1.
    1. WHO What Is Overweight and Obesity? [(accessed on 23 September 2019)]; Available online:
    1. WHO Report of the Commission on Ending Childhood Obesity. [(accessed on 13 September 2019)]; Available online: .
    1. Davison K.K., Birch L.L. Childhood overweight: A contextual model and recommendations for future research. Obes. Rev. 2001;2:159–171. doi: 10.1046/j.1467-789x.2001.00036.x.
    1. Sahoo K., Sahoo B., Choudhury A.K., Sofi N.Y., Kumar R., Bhadoria A.S. Childhood obesity: Causes and consequences. J. Fam. Med. Prim. Care. 2015;4:187.
    1. Jongenelis M.I., Scully M., Morley B., Pratt I.S., Slevin T. Physical activity and screen-based recreation: Prevalences and trends over time among adolescents and barriers to recommended engagement. Prev. Med. 2018;106:66–72. doi: 10.1016/j.ypmed.2017.10.006.
    1. Tanaka C., Reilly J.J., Huang W.Y. Longitudinal changes in objectively measured sedentary behaviour and their relationship with adiposity in children and adolescents: Systematic review and evidence appraisal. Obes. Rev. 2014;15:791–803. doi: 10.1111/obr.12195.
    1. Harris K.C., Kuramoto L.K., Schulzer M., Retallack J.E. Effect of school-based physical activity interventions on body mass index in children: A meta-analysis. Cmaj. 2009;180:719–726. doi: 10.1503/cmaj.080966.
    1. Griffiths L.J., Sera F., Cortina-Borja M., Law C., Ness A., Dezateux C. Objectively measured physical activity and sedentary time: Cross-sectional and prospective associations with adiposity in the Millennium Cohort Study. BMJ Open. 2016;6:e010366. doi: 10.1136/bmjopen-2015-010366.
    1. Ekelund U., Luan J., Sherar L.B., Esliger D.W., Griew P., Cooper A., International Children’s Accelerometry Database C. Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA. 2012;307:704–712. doi: 10.1001/jama.2012.156.
    1. Ahn S., Fedewa A.L. A meta-analysis of the relationship between children’s physical activity and mental health. J. Pediatr. Psychol. 2011;36:385–397. doi: 10.1093/jpepsy/jsq107.
    1. Lubans D.R., Smith J.J., Plotnikoff R.C., Dally K.A., Okely A.D., Salmon J., Morgan P.J. Assessing the sustained impact of a school-based obesity prevention program for adolescent boys: The ATLAS cluster randomized controlled trial. Int. J. Behav. Nutr. Phys. Act. 2016;13:92. doi: 10.1186/s12966-016-0420-8.
    1. Baranowski T. Exergaming: Hope for future physical activity? or blight on mankind? J. Sport Health Sci. 2017;6:44–46. doi: 10.1016/j.jshs.2016.11.006.
    1. Kriemler S., Meyer U., Martin E., van Sluijs E.M., Andersen L.B., Martin B.W. Effect of school-based interventions on physical activity and fitness in children and adolescents: A review of reviews and systematic update. Br. J. Sports Med. 2011;45:923–930. doi: 10.1136/bjsports-2011-090186.
    1. Demetriou Y., Honer O. Physical activity interventions in the school setting: A systematic review. Psychol. Sport Exerc. 2012;13:186–196. doi: 10.1016/j.psychsport.2011.11.006.
    1. Van de Kop J.H., van Kernebeek W.G., Otten R.H.J., Toussaint H.M., Verhoeff A.P. School-Based Physical Activity Interventions in Prevocational Adolescents: A Systematic Review and Meta-Analyses. J. Adolesc. Health. 2019;65:185–194. doi: 10.1016/j.jadohealth.2019.02.022.
    1. Hynynen S.T., van Stralen M.M., Sniehotta F.F., Araújo-Soares V., Hardeman W., Chinapaw M.J.M., Vasankari T., Hankonen N. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents. Int. Rev. Sport Exerc. Psychol. 2016;9:22–44. doi: 10.1080/1750984X.2015.1081706.
    1. Hung L.-S., Tidwell D.K., Hall M.E., Lee M.L., Briley C.A., Hunt B.P. A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity. Nutr. Res. 2015;35:229–240. doi: 10.1016/j.nutres.2015.01.002.
    1. Sigmund E., Sigmundová D. Longitudinal 2-year follow-up on the effect of a non-randomised school-based physical activity intervention on reducing overweight and obesity of Czech children aged 10–12 years. Int. J. Environ. Res. Public Health. 2013;10:3667–3683. doi: 10.3390/ijerph10083667.
    1. Sacchetti R., Ceciliani A., Garulli A., Dallolio L., Beltrami P., Leoni E. Effects of a 2-year school-based intervention of enhanced physical education in the primary school. J. Sch. Health. 2013;83:639–646. doi: 10.1111/josh.12076.
    1. Pbert L., Druker S., Barton B., Schneider K.L., Olendzki B., Gapinski M.A., Kurtz S., Osganian S. A school-based program for overweight and obese adolescents: A randomized controlled trial. J. Sch. Health. 2016;86:699–708. doi: 10.1111/josh.12428.
    1. Kahn E.B., Ramsey L.T., Brownson R.C., Heath G.W., Howze E.H., Powell K.E., Stone E.J., Rajab M.W., Corso P. The effectiveness of interventions to increase physical activity. A systematic review. Am. J. Prev. Med. 2002;22:73–107. doi: 10.1016/S0749-3797(02)00434-8.
    1. Thomas B.H., Ciliska D., Dobbins M., Micucci S. A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews Evid. Based Nurs. 2004;1:176–184. doi: 10.1111/j.1524-475X.2004.04006.x.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535.
    1. Almas A., Islam M., Jafar T.H. School-based physical activity programme in preadolescent girls (9–11 years): A feasibility trial in Karachi, Pakistan. Arch. Dis. Child. 2013;98:515–519. doi: 10.1136/archdischild-2012-303242.
    1. Aperman-Itzhak T., Yom-Tov A., Vered Z., Waysberg R., Livne I., Eilat-Adar S. School-Based Intervention to Promote a Healthy Lifestyle and Obesity Prevention Among Fifth- and Sixth-Grade Children. Am. J. Health Educ. 2018;49:289–295. doi: 10.1080/19325037.2018.1486755.
    1. Bhave S., Pandit A., Yeravdekar R., Madkaikar V., Chinchwade T., Shaikh N., Shaikh T., Naik S., Marley-Zagar E., Fall C.H.D. Effectiveness of a 5-year school-based intervention programme to reduce adiposity and improve fitness and lifestyle in Indian children; the SYM-KEM study. Arch. Dis. Child. 2016;101:33–40. doi: 10.1136/archdischild-2015-308673.
    1. Brown E.C., Buchan D.S., Cavana J., Baker J.S., Wyatt F.B., Kilgore J.L. Fit for school: Results of a 10-week school-based child healthy weight pilot intervention for primary school students. Int. J. Health Promot. Educ. 2016;54:229–244. doi: 10.1080/14635240.2016.1157511.
    1. Carlson J.A., Engelberg J.K., Cain K.L., Conway T.L., Mignano A.M., Bonilla E.A., Geremia C., Sallis J.F. Implementing classroom physical activity breaks: Associations with student physical activity and classroom behavior. Prev. Med. 2015;81:67–72. doi: 10.1016/j.ypmed.2015.08.006.
    1. Eather N., Morgan P.J., Lubans D.R. Improving the fitness and physical activity levels of primary school children: Results of the Fit-4-Fun group randomized controlled trial. Prev. Med. 2013;56:12–19. doi: 10.1016/j.ypmed.2012.10.019.
    1. Grydeland M., Bjelland M., Anderssen S.A., Klepp K.I., Bergh I.H., Andersen L.F., Ommundsen Y., Lien N. Effects of a 20-month cluster randomised controlled school-based intervention trial on BMI of school-aged boys and girls: The HEIA study. Br. J. Sports Med. 2014;48:768–773. doi: 10.1136/bjsports-2013-092284.
    1. Hollis J.L., Sutherland R., Campbell L., Morgan P.J., Lubans D.R., Nathan N., Wolfenden L., Okely A.D., Davies L., Williams A., et al. Effects of a ‘school-based’ physical activity intervention on adiposity in adolescents from economically disadvantaged communities: Secondary outcomes of the ‘Physical Activity 4 Everyone’ RCT. Int. J. Obes. 2016;40:1486–1493. doi: 10.1038/ijo.2016.107.
    1. Kipping R.R., Howe L.D., Jago R., Campbell R., Wells S., Chittleborough C.R., Mytton J., Noble S.M., Peters T.J., Lawlor D.A. Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial. BMJ. 2014;348:g3256. doi: 10.1136/bmj.g3256.
    1. Kriemler S., Zahner L., Schindler C., Meyer U., Hartmann T., Hebestreit H., Brunner-La Rocca H.P., van Mechelen W., Puder J.J. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: Cluster randomised controlled trial. BMJ. 2010;340:c785. doi: 10.1136/bmj.c785.
    1. Li X.H., Lin S.T., Guo H.X., Huang Y.L., Wu L.J., Zhang Z.L., Ma J., Wang H.J. Effectiveness of a school-based physical activity intervention on obesity in school children: A nonrandomized controlled trial. BMC Public Health. 2014:14. doi: 10.1186/1471-2458-14-1282.
    1. Lynch B.A., Gentile N., Maxson J., Quigg S., Swenson L., Kaufman T. Elementary School-Based Obesity Intervention Using an Educational Curriculum. J. Prim. Care Community Health. 2016;7:265–271. doi: 10.1177/2150131916644888.
    1. Madsen K., Linchey J., Gerstein D., Ross M., Myers E., Brown K., Crawford P. Energy Balance 4 Kids with Play: Results from a Two-Year Cluster-Randomized Trial. Child. Obes. 2015;11:375–383. doi: 10.1089/chi.2015.0002.
    1. Magnusson K.T., Hrafnkelsson H., Sigurgeirsson I., Johannsson E., Sveinsson T. Limited effects of a 2-year school-based physical activity intervention on body composition and cardiorespiratory fitness in 7-year-old children. Health Educ. Res. 2012;27:484–494. doi: 10.1093/her/cys049.
    1. Shore S.M., Sachs M.L., DuCette J.P., Libonati J.R. Step-Count Promotion through a School-Based Intervention. Clin. Nurs. Res. 2014;23:402–420. doi: 10.1177/1054773813485240.
    1. Sigmund E., El Ansari W., Sigmundova D. Does school-based physical activity decrease overweight and obesity in children aged 6–9 years? A two-year non-randomized longitudinal intervention study in the Czech Republic. BMC Public Health. 2012;12:570. doi: 10.1186/1471-2458-12-570.
    1. Thivel D., Isacco L., Lazaar N., Aucouturier J., Ratel S., Dore E., Meyer M., Duche P. Effect of a 6-month school-based physical activity program on body composition and physical fitness in lean and obese schoolchildren. Eur. J. Pediatrics. 2011;170:1435–1443. doi: 10.1007/s00431-011-1466-x.
    1. Tian H.L., du Toit D., Toriola A.L. The effects of an enhanced quality Physical Education programme on the physical activity levels of Grade 7 learners in Potchefstroom, South Africa. Phys. Educ. Sport Pedagog. 2017;22:35–50. doi: 10.1080/17408989.2015.1072509.
    1. Vander Ploeg K.A., McGavock J., Maximova K., Veugelers P.J. School-based health promotion and physical activity during and after school hours. Pediatrics. 2014;133:e371–e378. doi: 10.1542/peds.2013-2383.
    1. Haerens L., Kirk D., Cardon G., De Bourdeaudhuij I. Toward the development of a pedagogical model for health-based physical education. Quest. 2011;63:321–338. doi: 10.1080/00336297.2011.10483684.
    1. O’Sullivan M. New Directions, New Questions: Relationships between Curriculum, Pedagogy, and Assessment in Physical Education. Sport Edu. Soc. 2013;18:1–5. doi: 10.1080/13573322.2012.719868.
    1. Castelli D.M., Barcelona J.M., Bryant L. Contextualizing physical literacy in the school environment: The challenges. J. Sport Health Sci. 2015;4:156–163. doi: 10.1016/j.jshs.2015.04.003.
    1. Rowling L., Samdal O. Filling the black box of implementation for health-promoting schools. Health Educ. 2011;111:347–362. doi: 10.1108/09654281111161202.
    1. Naylor P.J., Nettlefold L., Race D., Hoy C., Ashe M.C., Wharf Higgins J., McKay H.A. Implementation of school based physical activity interventions: A systematic review. Prev. Med. 2015;72:95–115. doi: 10.1016/j.ypmed.2014.12.034.
    1. De Bourdeaudhuij I., Van Cauwenberghe E., Spittaels H., Oppert J.M., Rostami C., Brug J., Van Lenthe F., Lobstein T., Maes L. School-based interventions promoting both physical activity and healthy eating in Europe: A systematic review within the HOPE project. Obes. Rev. 2011;12:205–216. doi: 10.1111/j.1467-789X.2009.00711.x.
    1. Whitehead J., Fox K. Student-centred physical education. Bull. Phys. Educ. 1983;19:21–30.
    1. McKenzie T.L., Sallis J.F., Rosengard P. Beyond the stucco tower: Design, development, and dissemination of the SPARK physical education programs. Quest. 2009;61:114–127. doi: 10.1080/00336297.2009.10483606.
    1. Guerra P.H., Nobre M.R., Silveira J.A., Taddei J.A. The effect of school-based physical activity interventions on body mass index: A meta-analysis of randomized trials. Clinics. 2013;68:1263–1273. doi: 10.6061/clinics/2013(09)14.
    1. Sharma M. School-based interventions for childhood and adolescent obesity. Obes. Rev. 2006;7:261–269. doi: 10.1111/j.1467-789X.2006.00227.x.
    1. Brown T., Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes. Rev. 2009;10:110–141. doi: 10.1111/j.1467-789X.2008.00515.x.
    1. Yuksel H.S. Experiences of Prospective Physical Education Teachers on Active Gaming within the Context of School-Based Physical Activity. Eur. J. Educ. Res. 2019;8:199–211.
    1. Grasten A. School-based physical activity interventions for children and youth: Keys for success. J. Sport Health Sci. 2017;6:290–291. doi: 10.1016/j.jshs.2017.03.001.
    1. Fairclough S., Stratton G. Physical activity levels in middle and high school physical education: A review. Pediatric Exerc. Sci. 2005;17:217–236. doi: 10.1123/pes.17.3.217.
    1. Wallhead T.L., Buckworth J. The Role of Physical Educationin the Promotionof Youth Physical Activity. Quest. 2004;56:285–301. doi: 10.1080/00336297.2004.10491827.
    1. Dobbins M., De Corby K., Robeson P., Husson H., Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst. Rev. 2009 doi: 10.1002/14651858.CD007651.
    1. Gorely T., Nevill M.E., Morris J.G., Stensel D.J., Nevill A. Effect of a school-based intervention to promote healthy lifestyles in 7–11 year old children. Int. J. Behav. Nutr. Phys. Act. 2009;6:5. doi: 10.1186/1479-5868-6-5.
    1. Minatto G., Petroski E.L., Silva K.S.d., Duncan M.J. School-Based Intervention on Cardiorespiratory Fitness in Brazilian Students: A Nonrandomized Controlled Trial. J. Funct. Morphol. Kinesiol. 2019;4:10. doi: 10.3390/jfmk4010010.
    1. McKenzie T.L., Lounsbery M.A. School physical education: The pill not taken. Am. J. Lifestyle Med. 2009;3:219–225. doi: 10.1177/1559827609331562.
    1. Greco G., Cataldi S., Fischetti F. Effectiveness of a Short After-School Intervention on Physical Fitness in School-Aged Children. J. Theor. Res. Edu. 2019;14:143–164.

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