Improving the fitness and physical activity levels of primary school children: Results of the Fit-4-Fun group randomized controlled trial
Highlights
► Fit-4-Fun is an effective multi-component physical activity intervention. ► The fitness levels of children improve using enjoyable vigorous physical activities. ► Physical activity behaviors improve using a multi-component school-based intervention. ► Curriculum, environment and family partnerships influence physical activity behaviors.
Introduction
Physical fitness is an important predictor of physical and psychologi cal health in young people (Ortega et al., 2008, Parfitt et al., 2009). Recent studies demonstrate that children who display high levels of health-related fitness (HRF) (e.g. cardiorespiratory fitness, muscular fitness, flexibility and body composition), have a decreased risk of developing cardiovascular disease and other chronic illnesses (McMurray and Anderson, 2010), are less likely to suffer from anxiety and depression (Parfitt et al., 2009), and are more likely to perform better academically (Grissom, 2005, Van Dusen et al., 2011). Evidence also confirms that a large proportion of children are unfit (Ortega et al., 2011, Tomkinson et al., 2003), that children's fitness levels decline with age and fatness levels increase with age (Stratton et al., 2007), and that children do not participate in physical activity of sufficient volume and intensity to accrue the associated health benefits (Booth et al., 2005, Currie et al., 2008, Ortega et al., 2011). Considering the low levels of physical activity typically observed among youth (AHKC, 2012, Ekelund et al., 2011, Hardy et al., 2010) and secular declines in youth fitness levels (Boddy et al., 2012, Tomkinson and Olds, 2007, Tremblay et al., 2010), there is an urgent need to develop and evaluate interventions that promote high intensity activity but that are also appealing to young people. Indeed, the latest national physical activity guidelines include physical fitness parameters (USDHHS, 2009).
The school, via the curriculum, school ethos and community, has been widely acknowledged as an ideal setting in which to provide physical activity opportunities and to educate students about the importance of physical activity and the value of achieving and/or maintaining HRF standards (IUHPE, 2008, USDHHS, 2009). The Health and Physical Education (HPE) curriculum is considered to be focal point for physical activity promotion in the school setting (Centers for Disease Control and Prevention, 2011, Crawford, 2009, Kriemler et al., 2011). However, studies have questioned the quality and quantity of HPE lessons delivered in primary schools (McKenzie et al., 1993, McKenzie et al., 1994, McKenzie et al., 1995, Morgan and Hansen, 2007), with teachers reporting a range of barriers to achieving important student outcomes (Fairclough and Stratton, 2005, Kriemler et al., 2011, Morgan and Hansen, 2008a, Morgan and Hansen, 2008b). Evidently, the development of effective HPE programs that teachers can feasibly deliver, is clearly warranted.
Research in the area of physical activity and HRF in children is growing and the importance of designing and implementing quality HRF programs for children has emerged in the literature (Kriemler et al., 2011). A recent review of school-based physical activity and HRF interventions reported significant treatment effects in at least one measure of physical activity (for all 20 interventions), and 6 out of 11 trials reported a significant positive effect on HRF (Kriemler et al., 2011). However, only two of these physical activity interventions were considered high quality due to their rigorous methodological processes, and the fitness focus was often limited to cardiorespiratory fitness (CRF), rather than all HRF components (Kriemler et al., 2011). There is also limited evidence for physical activity and fitness programs that have a theoretical framework and adopt a multi-component approach (including a HPE curriculum component, behavior modification focus, family involvement, and delivered by a PE expert) — thus restricting their potential impact on fitness and behavior (Dobbins et al., 2009).
The Fit-4-Fun study was designed to overcome the limitations identified in the literature and to evaluate an innovative school-based physical activity program that utilized the three critical components of the Health Promoting School (HPS) framework (IUHPE, 2008). The Fit-4-Fun program aimed to build a school environment/ethos that supports physical activity, to create links between the school and the home via parental and family involvement in the program, and to support teaching and learning through the implementation of a quality HPE program. The Fit-4-Fun program was also based on Bandura's Social Cognitive Theory and Harter's Competence Motivation Theory and aimed to address possible mediators of behavior change in relation to physical activity in children (e.g. social support, self-efficacy, supportive environment, enjoyment) (Bandura, 1986, Harter, 1985). The feasibility of the Fit-4-Fun program was established in a small pilot study and the program was refined based on the process evaluation findings (Eather et al., 2012). The aim of the current study was to evaluate the Fit-4-Fun program in a cluster randomized controlled trial.
Section snippets
Study design and participants
Ethics approval for this study was obtained from the University of Newcastle, NSW, Australia and the Newcastle-Maitland Catholic Schools Office, and is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12611000976987). School Principals, teachers, parents and study participants provided written informed consent. The methods of the Fit-4-Fun study have been reported in detail elsewhere (Eather et al., 2011).
Sample size calculation
A power calculation was conducted to determine the sample
Overview
Fig. 1 illustrates the flow of participants through the trial. Four primary schools were recruited and 213 participants were assessed at baseline in April, 2011. The treatment and control groups were similar for all but 2 outcome measures (sit and reach test and the 7-stage sit up test) at baseline. Table 2 displays baseline demographic information and reports baseline primary and secondary outcomes.
Changes in primary and secondary outcomes
All 3-month and 6-month data are displayed in Table 3. The 6-month data will be discussed in
Discussion
The primary aim of this study was to evaluate the impact of a novel, multi-component school-based intervention on HRF and objectively measured physical activity in primary school children. Fit-4-Fun was an innovative fitness education program promoting and providing opportunities for vigorous intensity activity to improve HRF. Treatment effects at 6-month follow-up were found for CRF, body composition, flexibility, muscular fitness (sit-ups) and physical activity. Our process data also supports
Conclusion
In summary, the Fit-4-Fun program resulted in significant improvements in HRF, including, CRF fitness, body composition and flexibility, and improved physical activity levels. Our findings provide further evidence to support the effectiveness of a multi-component school-based fitness intervention for improving the physical fitness and physical activity levels of primary school children.
Author contributions
Study concept and design: Eather, Morgan, Lubans. Acquisition of data: Eather. Analysis and interpretation of data: Eather. Drafting of manuscript: Eather. Critical revision of the manuscript: Morgan and Lubans. Statistical analysis: Eather and Lubans. Obtained funding: Eather, Lubans, Morgan.
Financial disclosure
This research project was funded by The Physical Activity and Nutrition Research Centre (The University of Newcastle) and Sports Medicine Australia (research grant).
Conflict of interest statement
The authors declare that they have no conflicts of interests.
Acknowledgments
We would like to thank the following research assistants: Lauren Devereux, Darryn Eather, Peter Lavender, Julie Skinner, Joanne Graham, Jodie Rauch, Lauren Tongue, Lauren Wright, Emma Kavanagh, Emma Champion, Amanda Wintle, Karen Lewis, Elle Coates, Todd Cooper, Ashley Whitemore, Clare Williams, Hollie Tose, Courtney Platt, George Collins, Nicholas Redgrove, Sharyn Keiraz, Josie Bonfield, Sarah Toole, Stephanie Ryan, Belinda Avis, Annie Broderick, Tara Finn, Emily Floyd, Alyce Cook, Ms Tara
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