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Br J Sports Med. 2021 Jan 13; doi: 10.1136/bjsports-2020-102740. Epub 2021 Jan 13.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

British journal of sports medicine

Timothy Bryan Hartwig, Taren Sanders, Diego Vasconcellos, Michael Noetel, Philip D Parker, David Revalds Lubans, Susana Andrade, Manuel Ávila-García, John Bartholomew, Sarahjane Belton, Naomi E Brooks, Anna Bugge, Iván Cavero-Redondo, Lars Breum Christiansen, Kristen Cohen, Tara Coppinger, Sindre Dyrstad, Vanessa Errisuriz, Stuart Fairclough, Trish Gorely, Francisco Javier Huertas-Delgado, Johann Issartel, Susi Kriemler, Silje Eikanger Kvalø, Pedro Marques-Vidal, Vicente Martinez-Vizcaino, Niels Christian Møller, Colin Moran, John Morris, Mary Nevill, Angélica Ochoa-Avilés, Mai O'Leary, Louisa Peralta, Karin A Pfeiffer, Jardena Puder, Andrés Redondo-Tébar, Lorraine B Robbins, Mairena Sanchez-Lopez, Jakob Tarp, Sarah Taylor, Pablo Tercedor, Mette Toftager, Emilio Villa-González, Niels Wedderkopp, Kathryn Louise Weston, Zenong Yin, Zhou Zhixiong, Chris Lonsdale, Borja Del Pozo Cruz

Affiliations

  1. School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, New South Wales, Australia [email protected].
  2. Institute for Positive Psychology and Education, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia.
  3. School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia.
  4. Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.
  5. Faculty of Philosophy, Letters and Education Sciences, University of Cuenca, Cuenca, Azuay, Ecuador.
  6. Department of Physical Education and Sports, University of Granada, Granada, Andalucía, Spain.
  7. Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA.
  8. School of Health and Human Performance, Dublin City University, Dublin, Ireland.
  9. Faculty of Health Sciences and Sport, University of Stirling, Stirling, Stirling, UK.
  10. Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy Faculty of Health, University of Copenhagen, Kobenhavn, Denmark.
  11. Social and Health Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.
  12. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
  13. Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle Faculty of Science, Callaghan, New South Wales, Australia.
  14. Department of Sport, Leisure and Childhood Studies, Cork Institute of Technology, Cork, Cork, Ireland.
  15. Department of Public Health, University of Stavanger, Stavanger, Norway.
  16. Latino Research Institute, University of Texas at Austin, Austin, Texas, USA.
  17. Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, UK.
  18. Department of Nursing and Midwifery, University of the Highlands and Islands Inverness College, Inverness, Highland, UK.
  19. Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, ZH, Switzerland.
  20. Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  21. Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
  22. Department of Sport Science, Nottingham Trent University, Nottingham, Nottinghamshire, UK.
  23. Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador.
  24. Sydney School of Education and Social Work, University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia.
  25. Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.
  26. Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
  27. Health and Social Research Center, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain.
  28. Nursing Education and Research, Michigan State University, East Lansing, Michigan, USA.
  29. Department of Sports Medicine, Norwegian School ofSports Sciences, Oslo, Norway.
  30. Physical Activity Exchange, Research Institute for Sport andExercise Sciences, Liverpool John Moores University, Liverpool, UK.
  31. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
  32. Orthopedic Department, Hospital Of Southwestern Jutland, Esbjerg, Denmark.
  33. School of Applied Sciences Sighthill Campus, Edinburgh Napier University, Edinburgh, UK.
  34. Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA.
  35. Institute for Sport Performance and Health Promotion, Capital University of Sports and Physical Education, Beijing, China.

PMID: 33441332 DOI: 10.1136/bjsports-2020-102740

Abstract

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness.

DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity.

PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included.

MAIN OUTCOME MEASURES: Peak oxygen consumption (VO

RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness.

CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: cardiorespiratory fitness; individual participant data (IPD); moderate to vigorous physical activity; peak oxygen consumption; school-based physical activity intervention; youth

Conflict of interest statement

Competing interests: None declared.

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