Ingredients in the Recipe for Success of School-Based Physical Activity Interventions Karin Allor Pfeiffer, Ph.D. Department of Kinesiology Center for Physical Activity and Health Michigan State University

Outline Why are school-based physical activity interventions important? What do the data show? Which ingredients belong in the recipe for success? What are other considerations? What are practical ingredients in the recipe for success? Example (Project FIT)

Why are school-based physical activity interventions important? Approximately 40% of U.S. children and adolescents (6-11 years old) do not achieve recommended levels of physical activity (Troiano et al., MSSE, 2008) Physical activity sharply declines during adolescence (Pate et al., J Adolesc Health, 2009; Kimm et al., Lancet, 2005) Intervention prior to, during, and after the decline can all be useful Children in school are a captive audience

What do the data show? Recent literature reviews indicate Mostly positive results for increasing physical activity during school time Successful trials usually last longer and use multi-component approaches Questionable whether results apply to children only (adolescents?) Results may differ by type of physical activity assessment Dobbins et al., 2009; De Meester et al., 2009; Salmon et al., 2007; van Sluijs et al., 2007

What do the data show? (2) Latest review: Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Kriemler et al., Br J Sports Med, 2011; 45: Included studies from January 2007-December trials were relevant 16 of these reported effects with a physical activity outcome 14 included children up to 12 years old (4 adolescent, 2 included both) Half were multi-component 60% included a family or community component

What do the data show? (3) Results of Kriemler et al. Every study with a physical activity outcome reported a significant effect Nine of these addressed total physical activity (included time outside of school) and were effective Five used objective measures, four subjective measures of physical activity Two randomized controlled trials with intervention duration of one year provided the highest level of rigor and showed significant increase in physical activity (assessed by accelerometer)

What do the data show? (4) Noteworthy points regarding Kriemler et al. 20 trials were eligible to include in the review over a four-year time period In contrast, Dobbins review included 26 trials over 50 years 75% of those examining a physical activity outcome reported increase in overall physical activity Results extended to overall physical activity instead of in-school only (found in previous reviews) Similar results found for objective and subjective physical activity assessments

What do the data show? (5) Kriemler et al., contd. Studies including highest level of rigor and public health significance included Children Multi-component approach over one school year Integration into school curriculum with PE expert Family involvement

Which ingredients belong in the recipe for success? Multi-component approach over adequate time frame Include the family (may not be as relevant for adolescents) and environment (community) Establish sustainability Examine components of implementation and other aspects of intervention (and conduct formative evaluation)

Which ingredients belong in the recipe for success? (2) Examine mediation of the intervention effect Consider cost-effectiveness Consider reducing sedentary behaviors, particularly in combination with academic activities

What are other considerations? Little information is available regarding certain types of populations Cultural tailoring to racial/ethnic minority groups Novelty Media Technology Measurement tools Intervention tools Activity permissive environments Age group (elementary, middle, high school) Inter-generational efforts

What are practical ingredients in the recipe for success? Know your environment Understand that you are asking people to change behavior Find a champion for your cause Determine who in the setting is a stakeholder in your cause Communicate as much as possible Be collaborative rather than prescriptive

Example – Project FIT: A School- and Community-Based Intervention to Address Physical Activity and Healthy Eating in Low-Income Elementary School Children Elementary schools in Grand Rapids, MI (>95% of students in schools eligible for free/reduced-price lunch) Measures in children grades 3-5 Intervention lasted two years Guided by social ecological framework Multi-component School, community, social marketing Eisenmann et al., BMC Public Health, 2011, 11:607

Project FIT (2) School-based intervention components Staff training 30 min structured physical activity during the school day 20 hours of nutrition education for the school year Healthy eating coaches in the school cafeteria Physical activity and nutrition policy improvements via coordinated school health team Staff wellness

Project FIT (3) Baseline results Mean age = 9.7 years 48% overweight/obese (6% severely obese) 30% met physical activity recommendations (7 days, 60 min/day) – pedometer data not yet available 24% met screen time recommendations (<2 hrs/day)

Project FIT (4) Preliminary examination of follow-up data Positive results for ST Fruits/vegetables Process evaluation from first year, grades 3-5 Average of ~9 min/day of PA Average of 4.5 hours/classroom of nutrition education Process evaluation from first year, grades K-2 Average of ~10 min/day of PA Average of 7 hours/classroom of nutrition education

Summary School-based intervention research has progressed in recent years More work to be performed Use provided ingredients in recipe for success in school-based interventions; the chef has to appropriately combine and prepare

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