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

Children in grades 3-5 and their parents in five primary schools received the 17-week 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.

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.

Proportion of eligible primary schools that agreed to participate.

Proportion of eligible children in grades 3-5 whose parents gave written consent.

Proportion of enrolled children followed up at 18 weeks.

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.

Mean minutes per class required to complete the child questionnaire and to measure anthropometry and blood pressure.

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.

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.

Calculated from measured height and weight using the WHO 2007 growth reference.

Proportion of children with overweight (BMI-for-age z-score > +1 to +2) or obesity (z-score > +2) according to WHO 2007 cut-offs.

Measured in centimetres midway between the lowest rib and the iliac crest.

Measured in mmHg with a validated oscillometric device; classified using the American Academy of Pediatrics 2017 tables.

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.

Child-reported dietary questionnaire on intake of fruit and vegetables, sugar-sweetened beverages and fast food in the past 7 days.

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 usual nightly sleep duration in hours.

Parent questionnaire scores for knowledge, attitudes and practices regarding childhood healthy weight, diet and physical activity.