School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18

 

Abstract

Background

The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease.

Objectives

The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

Search methods

The search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

Selection criteria

To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group.

Data collection and analysis

Standardized tools were used by two independent reviewers to rate each study’s methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations,  interventions evaluated and outcomes measured.

Main results

13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for  duration of physical activity, television viewing,  VO₂ max, and blood cholesterol. Generally school-based  interventions had no  effect on leisure time physical activity rates,  systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects.

Authors' conclusions

Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time.

 

Plain language summary

School-based interventions for promoting physical activity and fitness in children and adolescents

Current evidence suggests that school-based physical activity interventions may be effective in the development of healthy lifestyle behaviours among children and adolescents that will then translate into reduced risk for many chronic diseases and cancers in adulthood. The evidence also suggests that the best primary strategy for improving the long-term health of children and adolescents through exercise may be creating lifestyle patterns of regular physical activity that carry over to the adult years.

It is estimated that as many at 1.9 million deaths worldwide are attributable to physical inactivity, and that inactivity is a key risk factor in the development of most chronic diseases and cancers.

This is alarming particularly because it is known that physical activity patterns track from childhood into adulthood; that children are increasingly exhibiting risk factors for cardiovascular disease, such as obesity, elevated blood lipids, and hypertension, conditions which are known to track into adulthood; and that atherosclerotic fatty streaks in the coronary arteries, which are indicative of coronary heart disease, have been found postmortem in children.

This review included 26 studies that evaluated the impact of combinations of school-based interventions focused on increasing physical activity among children and adolescents. Participants were between the ages of 6 to18 living in Australia, South America, Europe and North America.

There is good evidence that school-based physical activity interventions are effective in increasing duration of physical activity, reducing blood cholesterol and time spent watching television and increasing VO₂ max. VO₂ max, known as maximal oxygen uptake or aerobic capacity, reflects the physical fitness level of an individual and generally increases as fitness levels improve. These interventions are not effective in increasing the percentage of children and adolescents who are physically active during leisure time, or in reducing systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects for four of the nine outcomes.

 

摘要

背景

以學校為基礎的身體活動方案來促進6−18歲兒童與青少年的身體活動和健康

據世界衛生組織估計，全世界有190萬例死亡歸因於缺乏運動。導致缺乏身體活動的慢性疾病，包括癌症，糖尿病和冠心病。

目標

本系統性文獻回顧的目的是總結以學校為基礎的介入活動對於促進兒童與青少年身體健康的效力的證據。

搜尋策略

搜索戰略包括搜尋數個資料庫。另外，針對可能相關的研究，其參考文獻所列之文章，和相關Cochrane的回顧文獻進行審查。同時和納入研究的主要作者聯繫以獲得更多信息。

選擇標準

介入活動必須與公共衛生實務相關，由當地公共衛生單位的工作人員執行，促進或推動，落實到學校的環境並以增加身體活動為宗旨，報告著重在兒童與青少年(年齡6至18歲)的成果，並使用前瞻性設計與對照組。

資料收集與分析

由兩個獨立的審查員利用標準化工具對於每項研究的方法學品質和數據提取進行評分。如果出現差異則會進行討論，直到達成共識。由於各研究的族群，介入評估和結果衡量的差異大，結果將以敘事方式進行總結。

主要結論

共篩選出13841個標題，收入482篇文獻。將多個來自同一個計畫的發表文章合併計算為一個項目後，共計收入395個不同的計劃(研究)。這395個研究中，有104個被視為較具有相關性，其中4個被評估為有較強的方法學質量，22個為中等，78個為薄弱的。最後共有26個研究被收入此回顧研究中。有充分證據顯示以學校為基礎的身體活動介入措施對於9個結果中的4個，包含身體活動的時間，看電視的時間，最大攝氧量(VO2 max)和血液中的膽固醇產生正向影響。大體而言，以學校為基礎的介入活動對於休閒時間的身體活動率，收縮壓，舒張壓，身體質量指數和脈搏是沒有影響的。至少，結合印刷教材和改變學校課程對於促進身體活動有產生正向的影響。

作者結論

由於身體活動促進方案沒有有害的影響，同時有一些證據顯示對生活方式的行為與態度和身體健康狀況有正向的影響，因此此時會建議持續在學校進行身體活動促進方案。

翻譯人

本摘要由臺灣大學附設醫院吳婉禎翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以學校為基礎的介入活動來促進6−18歲兒童與青少年的身體活動和健康：目前的證據顯示，以學校為基礎的身體活動介入可能可以有效的促進兒童與青少年發展健康的生活方式與行為，這些將會減少成年時期許多慢性疾病和癌症的風險。證據也顯示，藉由運動來改善兒童與青少年長期健康的最佳戰略可能是透過創造規律的身體活動的生活形態並延續到成人時期。估計全世界190萬例死亡是由於缺乏運動，而缺乏運動是發展大多數慢性疾病和癌症的一個關鍵的風險因素。尤其是我們已知身體活動模式會從童年延續至成年，現在的孩童表現出越來越多心血管疾病的危險因子，如肥胖，血脂升高，高血壓，這些狀態已知會持續到成年，同時在死後的孩童身上也發現到有冠狀動脈心臟病的指標－冠狀動脈血管壁上的脂肪紋，這些都是令人擔憂的。這篇回顧調查概括了26個評估以學校為基礎的介入活動對於增進兒童與青少年身體活動的研究。參與者為6至18歲居住在澳大利亞，南美，歐洲和北美的兒童與青少年。有很好的證據顯示，以學校為基礎的身體活動介入措施可有效地提高身體活動的時間，降低血液膽固醇，減少花在看電視的時間和增加最大攝氧量。VO2 max，稱為最大攝氧量或有氧能力，反應出個人體能的水平，通常在體能水平進步時會提高。這些介入措施無法有效地增加兒童與青少年在休閒時間進行身體活動的百分比，無法降低收縮壓和舒張壓，無法降低身體質量指數或降低脈搏。至少，結合印刷教材和改變學校課程來促進身體活動對於9個結果中的4個有產生正向的影響。