Ingredients in the Recipe for Success of School-Based Physical Activity InterventionsKarin Allor Pfeiffer, Ph.D.

Department of Kinesiology

Center for Physical Activity and Health

Michigan State University

kap@msu.edu

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 indicateMostly 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; 45:923-930

Included studies from January 2007-December 2010

20 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., cont’d. 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

Thank You