The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials

Paulo Henrique Guerra, Moacyr Roberto Cuce Nobre, Jonas Augusto Cardoso da Silveira, José Augusto de Aguiar Carrazedo Taddei, Paulo Henrique Guerra, Moacyr Roberto Cuce Nobre, Jonas Augusto Cardoso da Silveira, José Augusto de Aguiar Carrazedo Taddei

Abstract

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n = 4,273, -0.02, 95% CI: -0.13 to 0.17, p = 0.8); body weight (5 trials, n = 1,330, -0.07, 95% CI: -0.18 to 0.04, p = 0.2); and blood pressure (6 trials, n = 1,549), including systolic (0.11, 95% CI: -0.10 to 0.31, p = 0.3) and diastolic pressure (-0.00, 95% CI: -0.10 to 0.10, p = 0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Meta-analysis flow chart.
Figure 2
Figure 2
Comparison of the effects of school-based interventions on the change in body mass index compared with controls.
Figure 3
Figure 3
Funnel plots of papers included in the body mass index synthesis (a) and body weight synthesis (b).
Figure 4
Figure 4
Comparison of the effects of school-based interventions on changes in body weight compared with controls.

References

    1. Wang Y, Monteiro C, Popkin BM. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr. 2002;75(6):971–7.
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549–55.
    1. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Surg Pathol. 2000;8(1):39–47.
    1. Neutzling MB, Taddei JA, Rodrigues EM, Sigulem DM. Overweight and obesity in Brazilian adolescents. Int J Obes Relat Metab Disord. 2000;24(7):869–74.
    1. Myers L, Coughlin SS, Webber LS, Srinivasan SR, Berenson GS. Prediction of adult cardiovascular multifactorial risk status from childhood risk factor levels. The Bogalusa Heart Study. Am J Epidemiol. 1995;142(9):918–24.
    1. Deshmukh-Taskar P, Nicklas TA, Morales M, Yang SJ, Zakeri I, Berenson GS. Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study. Eur J Clin Nutr. 2006;60(1):48–57.
    1. Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: The Bogalusa Heart Study. Pediatrics. 2005;115(1):22–7.
    1. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365(20):1876–85.
    1. Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes (Lond) 2010;34(1):18–28.
    1. Nobre MRC, Zanetta R Cols. Multiplicadores do Estilo de Vida Saudável - Prevenção de doença cardiovascular na adolescência. Porto Alegre: Artmed. 2011
    1. Datar A, Sturm R. Physical education in elementary school and body mass index: evidence from the early childhood longitudinal study. Am J Public Health. 2004;94(9):1501–6.
    1. Scheffler C, Ketelhut K, Mohasseb I. Does physical education modify the body composition? --results of a longitudinal study of pre-school children. Anthropol Anz. 2007;65(2):193–201.
    1. Sollerhed AC, Ejlertsson G. Physical benefits of expanded physical education in primary school: findings from a 3-year intervention study in Sweden. Scand J Med Sci Sports. 2008;18(1):102–7.
    1. Taylor RW, McAuley KA, Barbezat W, Farmer VL, Williams SM, Mann JI, et al. Two-year follow-up of an obesity prevention initiative in children: the APPLE project. Am J Clin Nutr. 2008;88(5):1371–7.
    1. Kanekar A, Sharma M. Meta-analysis of school-based childhood obesity interventions in the U.K. and U.S. Int Q Community Health Educ. 2008;29(3):241–56.
    1. Katz DL, O'Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond) 2008;32(12):1780–9.
    1. Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V. School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009;37(5):418–27.
    1. Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009;180(7):719–26.
    1. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;((12)):CD001871.
    1. Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health (Oxf) 2012;34(3):360–9.
    1. Friedrich RR, Schuch I, Wagner MB. Effect of interventions on the body mass index of school-age students. Rev SaudePublica. 2012;46(3):551–60.
    1. Atlantis E, Barnes EH, Singh MA. Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes (Lond) 2006;30(7):1027–40.
    1. Thomas J. EPPI-Reviewer 3.0: analysis and management of data for research synthesis. In: Brunton J, editor. EPPI-Centre Software: London. London: Social Science Research Unit, Institute of Education; 2009. editor.
    1. Thomas BH, 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(3):176–84.
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490–4.
    1. DerSimonian R, Laird N. Meta-Analysis in Clinical Trials. Control Clin Trials. 1986;7(3):177–88.
    1. Hatala R, Keitz S, Wyer P, Guyatt G, Evidence-Based Med Teaching T. Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results. CMAJ. 2005;172(5):661–5.
    1. Ahamed Y, MacDonald H, Reed K, Naylor PJ, Liu-Ambrose T, McKay H. School-based physical activity does not compromise children's academic performance. Med Sci Sports Exerc. 2007;39(2):371–6.
    1. Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, Sullivan DK, et al. Physical Activity Across the Curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med. 2009;49(4):336–41.
    1. Henaghan J, McWhannell N, Foweather L, Cable NT, Batterham AM, Stratton G, et al. The effect of structured exercise classes and a lifestyle intervention on cardiovascular risk factors in primary schoolchildren: An exploratory trial (the A-CLASS project) Pediatr Exerc Sci. 2008;20(2):169–80.
    1. Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H, et al. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ. 2010;340:c785.
    1. Lubans DR, Sheaman C, Callister R. Exercise adherence and intervention effects of two school-based resistance training programs for adolescents. Prev Med. 2010;50(1-2):56–62.
    1. Martinez Vizcaino V, Salcedo Aguilar F, Franquelo Gutierrez R, Solera Martinez M, Sanchez Lopez M, Serrano Martinez S, et al. Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial. Int J Obes (Lond) 2008;32(1):12–22.
    1. McManus AM, Masters RSW, Laukkanen RMT, Yu CCW, Sit CHP, Ling FCM. Using heart-rate feedback to increase physical activity in children. Prev Med. 2008;47(4):402–8.
    1. Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, et al. Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention. Int J Obes (Lond) 2008;32(10):1489–98.
    1. Thivel D, Isacco L, Lazaar N, Aucouturier J, Ratel S, Dore E, et al. Effect of a 6-month school-based physical activity program on body composition and physical fitness in lean and obese schoolchildren. Eur J Pediatr. 2011;170(11):1435–43.
    1. Verstraete SJM, Cardon GM, De Clercq DLR, De Bourdeaudhuij IMM. A comprehensive physical activity promotion programme at elementary school: the effects on physical activity physical fitness and psychosocial correlates of physical activity. Public Health Nutr. 2007;10(5):477–84.
    1. Walther C, Gaede L, Adams V, Gelbrich G, Leichtle A, Erbs S, et al. Effect of Increased Exercise in School Children on Physical Fitness and Endothelial Progenitor Cells A Prospective Randomized Trial. Circulation. 2009;120(22):2251–9.
    1. Young DR, Phillips JA, Yu T, Haythornthwaite JA. Effects of a life skills intervention for increasing physical activity in adolescent girls. Arch Pediatr Adolesc Med. 2006;160(12):1255–61.
    1. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. :1561–7. 282. United States. 1999.
    1. Yin Z, Gutin B, Johnson MH, Hanes J, Jr, Moore JB, Cavnar M, Thornburg J, et al. An environmental approach to obesity prevention in children: Medical College of Georgia FitKid Project year 1 results. Obes Res. 2005;13(12):2153–61.
    1. Salcedo Aguilar F, Martinez-Vizcaino V, Sanchez Lopez M, Solera Martinez M, Franquelo Gutierrez R, Serrano Martinez S, et al. Impact of an after-school physical activity program on obesity in children. J Pediatr. 2010;157(1):36–42 e3.
    1. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidencebased physical activity for school-age youth. J Pediatr. 2005;146(6):732–7.
    1. WHO. World Health Organization. Physical activity and young people. Geneva: 2008. Global strategy on diet, physical activity and health website.
    1. Lazaar N, Aucouturier J, Ratel S, Rance M, Meyer M, Duche P. Effect of physical activity intervention on body composition in young children: influence of body mass index status and gender. Acta Paediatr. 2007;96(9):1315–20.
    1. Woodman J, Lorenc T, Harden A, Oakley A. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.; Social and environmental interventions to reduce childhood obesity: a systematic map of reviews London: EPPI-Centre Technical Report no. 1610 (2008) September.
    1. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011;342:d549.
    1. Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess. 2003;7(41):1–90.
    1. Li M, Li S, Baur LA, Huxley RR. A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents. Obes Rev. 2008;9(6):548–59.

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