Health promotion | | | | |
Robinson23 (USA, 1999) | School children (grades 3–4)
Mean age: 8.9 years
% female: not given | I: An 18-lesson, 6-month classroom curriculum to reduce television, videotape, and videogame use (n=106)
C: Usual school curriculum (n=121)
Follow up: 7 months | Adjusted change in BMI (kg/m2) –0.45 (95% CI –0.73 to –-0.17, p=0.002)
Significantly greater reductions were also observed in the I group in terms of triceps skinfold thickness (p=0.002), waist circumference (p<0.001) and waist-to-hip ratio (p<0.001)
Intervention group children watched significantly less television (p<0.001) and played fewer video games (p<0.01) than control group children. The groups did not differ for videotape viewing, daily servings of high fat foods, physical activity levels, or cardiorespiratory fitness | Random allocation: Schools matched on sociodemographic and scholastic variables
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |
Physical activity | | | | |
Sallis25 (USA, 1993) | School children (grade 4)
Mean age: 9.25 years
44% female | Followed the Sports, Play, Active Recreation for Kids (SPARK) intervention, incorporating physical education and self-management into the school curriculum over an 18 month period
I1. Intervention led by certified physical education specialists (n=151)
I2. Intervention led by classroom teachers (n=200)
C: No intervention (n=198)
Follow up: 18 months | Results were presented as graphs only. Few significant differences were found between the groups in terms of BMI or triceps/calf skinfolds. However, at follow up, girls in the control group had a statistically lower increase in BMI than the other groups (p<0.01) | Random allocation: Schools stratified by % of ethnic minority students and size
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |
Mo-suwan24 (Thailand, 1998) | Kindergarten children
Mean age: 4.5 years
Sex: I=44% female, C=39% female | I: Kindergarten based physical activity programme conducted by specially trained staff and including a 15 minute walk and a 20 minute aerobic dance session 3 times a week. (n=158 baseline, 147 at end of study)
C: no intervention (n=152 baseline, 145 at end of study)
Follow up: 29.6 weeks | Prevalence of obesity:
Baseline: I=12.2%, C=11.7%; 29.6 weeks: I=8.8%, C=9.7%, p=0.057 | Random allocation: Randomisation of classes, stratified by school
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |
Multifaceted interventions | | | |
Sahota26 (UK, 2001) | School children (aged 7–11 years)
Mean age: I=8.36 years, C=8.42 years
Sex: I=49% female, C=41% female | I: Active Programme Promoting Lifestyle in Schools (APPLES). Programme designed to influence diet and physical activity and not simply knowledge. Targeted at the whole school community including parents, teachers and catering staff. The programme consisted of teacher training, modifications of school meals and the development and implementation of school action plans designed to promote healthy eating and physical activity (data collection: n=301 baseline, 292 follow up)
C: No intervention (data collection: n=312 baseline, 303 follow up)
Follow up: One year | Weighted mean difference in BMI:
Overweight children: –0.07 (95% CI –0.22 to 0.08)
Obese children: –0.05 (95% CI –0.22 to 0.11)
All children: 0 (95% CI –0.1 to 0.1) | Random allocation: Ten schools paired according to size, ethnicity and level of social disadvantage, randomised by coin toss
Blinding:
Children: Unclear
Providers: No
Outcome assessors: No |
DeWolfe56 (Canada, 1984) | Adolescent girls at least 5 lbs overweight
Mean age: 15.9 yrs | All participants attended an 8-week school based weight control programme, containing physical exercise and behavioural therapy components
I1: Monthly follow up with physical measurement, plus reinforcement of behavioural, diet and exercise components of the weight control program (n=4)
I2: Monthly follow up with physical measurement (n=6)
I3: Annual follow up with physical measurement (n=5)
Follow up: One year | % change in excess weight:
During programme: I1=–9.6, I2=–9.5, I3=–10.5
During follow up: I1=–26.4, I2=–19.9, I3=+40.6
Overall: I1=–34.1, I2=–24.7, I3=+21.1
Similar results for weight change and percentage weight change. Significance not assessed, due to small number of participants involved. | Random allocation: Method not described
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |
Flores29 (USA, 1995) | School children (aged 10–13 years)
Mean age: 12.6 years
54% female | I: Thrice weekly aerobic dance class plus health education in place of regular school physical education programme (n=43)
C: Usual physical activity (n=38)
Follow up: 12 weeks | For girls:
Change in BMI; I=–0.8, C=+0.3, p=<0.05
Change in heart rate (beats per min); I=–10.9, C=–0.2, p<0.01
For boys there were no differences between I and C groups | Random allocation: Randomisation of classrooms
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |
Gortmaker28 (USA, 1999) | School children (grades 6–8)
Mean age: 11.7 years
48% female | I: School-based interdisciplinary intervention focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable consumption and encouraging increases in physical activity (n=641)
C: No intervention (n=654)
Follow up: 18 months (2 school years) | Change in prevalence of obesity in girls (%):
C=+2.2, I=–3.3
Adjusted OR=0.47 (95% CI 0.24 to 0.93, p=0.03)
Change in prevalence of obesity in boys (%): C=–2.3, I=–1.5
Adjusted OR=0.85 (95% CI 0.52 to 1.39, p=0.48) | Random allocation: Ten schools matched according to town, size and ethnic composition, randomised using random number table
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |
Muller27 (Germany, 2001) | School children
Mean age: not given.
Age range 5–7 years
% female: not given | I: At school, an 8 hour course of nutrition education including “active” breaks given by a skilled nutritionist and a trained teacher. Included the following messages: “eat fruit and vegetables each day”, “reduce intake of high fat foods”, keep active at least 1 hour each day”, “decrease TV consumption to less than 1 hour per day”. (Additional family-based intervention plus a structured sports programme were offered to families with overweight or obese children and to families with normal weight children but obese parents) (n=136)
C: No intervention (n=161)
Follow up: One year | Median BMI (baseline, 1 year): I=15.2, 16.1; C=15.4, 16.3; p=NS
Median triceps skinfold (mm) (baseline, 1 year): I=10.9, 11.3; C=10.7, 13.0; p<0.01 | Random allocation: method not described
Blinding:
Children: Unclear
Providers: Unclear
Outcome assessors: Unclear |