McMaster University

McMaster University

School-based programs to get kids active just one piece of puzzle

A review of studies on beefed-up physical activity programs in schools found the interventions have some health benefits but little effect on the amount of exercise the kids do outside school.

Researchers went over data from 26 studies in North America, Europe, South America and Australia as part of a Cochrane review, published Wednesday in the Cochrane Library. No studies from Canada were included, but the lead researcher is based at McMaster University in Hamilton.

"Generally what we found was that school-based physical activity interventions are effective in getting kids to spend more time being physically active during school hours," said Maureen Dobbins, an associate professor at the university's School of Nursing.

"We did see a few studies demonstrate a positive impact on less television viewing ... What we also found was increased lung capacity."

However, there was little impact on weight or blood pressure, the review indicated.

But Dobbins suggested that measuring weight or focusing on body mass index, or BMI, isn't really an "appropriate outcome measure" because these were growing kids from the ages of six to 18.

"If we just think about weight, if you have the majority of your subjects - your students - that you're studying that are at an appropriate BMI ... then we wouldn't necessarily want to be resulting in a lower BMI or a lower weight with kids that are already at an OK weight."

The interventions in some programs involved teachers being trained to build more physical activity into non-phys-ed courses, she said.

Or there might be a "super phys-ed class" that would keep children "with an elevated heart rate for the whole gym class as opposed to different sports that might have kids sitting out, rotating on and off the court."

A control group was offered regular phys-ed classes, she said.

Many of the programs tried to keep the activities fun and engaging, and some removed the competitiveness.

In addition, the children were taught about the importance of physical activity to their health through materials geared for them, and for their families.

"What was disappointing was that we're not seeing more kids being engaged in physical activity outside of school," Dobbins said.

"How can we get a larger proportion of the population to be engaging in physical activity?"

"We need to have other strategies that really focus on getting children, and likely families, to be more active outside of those school hours."

She also highlighted evidence suggesting that the interventions have a different impact on boys and girls.

"So we need to understand that better ... one physical activity program may be more effective for boys than girls, and vice versa, so we likely need to tailor physical activity promotion according to gender."

NEWSWEEK article

Childhood Obesity and School Exercise Programs: Not So Fast
Tuesday, January 20, 2009 3:30 PM
By Sharon Begley

I hate to pour cold water on what seems like a surefire way to combat childhood obesity‹namely, school-based health and exercise programs‹so I¹ll blame the Cochrane Collaboration http://www.cochrane.org for doing so. This non-profit group of scientists and physicians, based in England, regularly assesses the weight of the evidence on health and medical questions from whether St. John¹s wort can alleviate depression http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000448/frame.html (yes, sort of) to whether mouthwash can reduce bad breath http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006701/f rame.html (in some cases). Now the Cochrane team has weighed in on whether school programs can help kids lose weight and inspire them to exercise more.

Answer: no, on both counts.

That¹s a little discouraging, given the renewed emphasis on using schools to combat the growing incidence of childhood obesity and its attendant diabetes http://healthlink.mcw.edu/article/941223597.html. Studies from Greece

http://www.ncbi.nlm.nih.gov/pubmed/18678585?ordinalpos=18&itool=EntrezSyste
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to England
http://www.ncbi.nlm.nih.gov/pubmed/18579898?ordinalpos=35&itool=EntrezSyste
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to Australia http://www.ncbi.nlm.nih.gov/pubmed/18274949?ordinalpos=52&itool=EntrezSystem2
.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_

DefaultReportPanel.Pubmed_RVDocSum and beyond have looked for correlations between physical inactivity and obesity, or school-based exercise programs and health benefits, calling almost unanimously for (to pick just one) ³necessary school interventions in order to encourage healthier behaviours and habits.² To be sure, school-based programs here and there have reported success in reducing obesity http://www.ncbi.nlm.nih.gov/pubmed/17825729?ordinalpos=86&itool=EntrezSyste
m2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
and fostering healthy habits, but the results tend to be equivocal, especially when it comes to getting kids to stick with the program.

Taken together, the 26 studies of school-based programs aimed at promoting physical activity in Australia, South America, Europe and North America which the Cochrane team examined increased how long children spend exercising and cut their TV-watching time. So far, so good. The programs also reduced blood cholesterol levels and improved lung capacity, a measure of fitness. But‹now the bad news‹the programs had little effect on weight or blood pressure or on what kids choose to do in their free time, the last being a crucial indication of whether the programs are likely to change lifestyle habits for the better.

³Given that there are at least some beneficial effects, we would recommend that schools continue their health promotion programs,² said Maureen Dobbins //www.fhs.mcmaster.ca/nursing/faculty_dobbins.shtml of the School of Nursing at McMaster University in Ontario, who led the review.

But why didn¹t the programs do what public health officials hope, namely take off pounds and instill lifelong healthy habits? ³Physical activity classes may be too closely associated with school work, so for some students this makes them feel like they are being made to do more work,² says Dobbins. In that case, the last thing kids want to do is more such ³work² on their own time, when a teacher isn¹t making them. Kind of like if you make reading a chore for kids, they think of it that way‹and never want to pick up another book unless they have to.

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