Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Original Article
  • Published:

Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial

International Journal of Obesity volume 32, pages 12–22 (2008)Cite this article

Abstract

Objective:

To assess the impact of a physical activity program on obesity in primary school children.

Design:

Cluster-randomized controlled trial with 10 intervention and 10 control schools.

Participants:

A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain.

Intervention:

Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks.

Main outcome measures:

Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization.

Results:

There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (−1.14 mm; 95% confidence interval (CI) −1.71 to −057; P<0.001) and girls (−1.55 mm; 95% CI −2.38 to −0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (−0.58%; 95% CI −1.04 to −0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (−4.59; 95% CI −8.81 to −0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95–19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19–2.91; P=0.03) in the intervention versus control boys.

Conclusion:

An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Lobstein T, Bauer L, Uauy R, IASO International Obesity Task Force. Obesity in children and young people: a crisis in public health. Obes Rev 2004; 5 (Suppl 1): 1–104.

    Google Scholar 

  2. Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C et al. Health Behaviour in School-Aged Children Obesity Working Group. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005; 6: 123–132.

    Article  CAS  Google Scholar 

  3. Serra Majem L, Ribas Barba L, Aranceta Bartrina J, Perez Rodrigo C, Saavedra Santana P, Pena Quintana L . Childhood and adolescent obesity in Spain. Results of the enKid study (1998–2000). Med Clin (Barc) 2003; 121: 725–732.

    Article  Google Scholar 

  4. Moreno LA, Sarría A, Fleta J, Marcos A, Bueno M . Secular trends in waist circumference in Spanish adolescents, 1995 to 2000–2002. Arch Dis Child 2005; 90: 818–819.

    Article  CAS  PubMed Central  Google Scholar 

  5. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  PubMed Central  Google Scholar 

  6. Martínez Vizcaíno V, Salcedo Aguilar F, Franquelo Gutiérrez R, Torrijos Regidor R, Morant Sánchez A, Solera Martínez M et al. Prevalencia de obesidad y tendencia de los factores de riesgo cardiovascular en escolares desde 1992 a 2004: estudio de Cuenca. Med Clin (Barc) 2006; 126: 681–685.

    Article  Google Scholar 

  7. Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111: 1999–2012.

    Article  Google Scholar 

  8. Summerbell CD, Waters E, Edmundo LD, Nelly S, Brown T, Campbell KJ . Interventions for preventing obesity in children. Cochrane Database Syst Rev 2006; 3: CD001871.

    Google Scholar 

  9. Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T et al. Pathways: school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr 2003; 78: 1030–1038.

    Article  CAS  PubMed Central  Google Scholar 

  10. Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J . Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 2001; 323: 1029–1032.

    Article  CAS  PubMed Central  Google Scholar 

  11. James J, Thomas P, Cavan D, Kerr D . Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomized controlled trial. BMJ 2004; 328: 1237.

    Article  PubMed Central  Google Scholar 

  12. Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999; 153: 409–418.

    Article  CAS  Google Scholar 

  13. Robinson TN . Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 1999; 282: 1561–1567.

    Article  CAS  Google Scholar 

  14. Doak CM, Visscher TL, Renders CM, Seidell JC . The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obes Rev 2006; 7: 111–136.

    Article  CAS  Google Scholar 

  15. Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH et al. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 2006; 333: 1041–1043.

    Article  PubMed Central  Google Scholar 

  16. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S et al. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet 2006; 368: 299–304.

    Article  Google Scholar 

  17. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ et al. Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA 1996; 275: 768–776.

    Article  CAS  Google Scholar 

  18. Donnelly JE, Jacobsen DJ, Whatley JE, Hill JO, Swift LL, Cherrington A et al. Nutrition and physical activity program to attenuate obesity and promote physical and metabolic fitness in elementary school children. Obes Res 1996; 4: 229–243.

    Article  CAS  Google Scholar 

  19. Kelley GA, Kelley KS, Tran ZV . The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol 2003; 6: 8–16.

    Article  PubMed Central  Google Scholar 

  20. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B et al. Evidence based physical activity for school-age youth. J Pediatr 2005; 146: 732–737.

    Article  Google Scholar 

  21. Campbell MK, Elbourne DR, Altman DG, CONSORT group. CONSORT statement: extension to cluster randomised trials. BMJ 2004; 328: 702–708.

    Article  PubMed Central  Google Scholar 

  22. Rowlands AV, Thomas PW, Eston RG, Topping R . Validation of the RT3 triaxial accelerometer for the assessment of physical activity. Med Sci Sports Exerc 2004; 36: 518–524.

    Article  Google Scholar 

  23. Pietrobelli A, Rubiano F, St-Onge MP, Heymsfield SB . New bioimpedance analysis system: improved phenotyping with whole-body analysis. Eur J Clin Nutr 2004; 58: 1479–1484.

    Article  CAS  PubMed Central  Google Scholar 

  24. El Assaad MA, Topouchian JA, Asmar RG . Evaluation of two devices for self-measurement of blood pressure according to the international protocol: the Omron M5-I and the Omron 705IT. Blood Press Monit 2003; 8: 127–133.

    Article  Google Scholar 

  25. Zak B . Cholesterol methodologies: a review. Clin Chem 1977; 23: 1201–1214.

    CAS  PubMed  Google Scholar 

  26. Shephard MDS, Whiting MJ . Falsely low estimation of triglycerides in lipemic plasma by the enzymatic triglyceride method with modified Trinder's chromogen. Clin Chem 1990; 36: 325–329.

    CAS  PubMed  Google Scholar 

  27. Rifai N, King ME . Inmunoturbidimetric assays of apolipoproteins A, Al, All and B in serum. Clin Chem 1986; 32: 957–961.

    CAS  PubMed  Google Scholar 

  28. World Health Organization. Physical Status: The Use and Interpretation of Anthropometry. World Health Organization: Geneva, 1995. WHO Technical Report Series, N0.854.

  29. Tanner JM . Fetus into Man. Harvard University Press: Cambridge Mass, 1990.

    Google Scholar 

  30. Donner A, Klar N . Design and Analysis of Cluster Randomization Trials in Health Research. Arnold: London, 2000.

    Google Scholar 

  31. Fitzmaurice GM, Laird NM, Ware JH . Applied Longitudinal Analysis. Wiley InterScience: Hoboken, NJ, 2004.

    Google Scholar 

  32. Daniels SR, Khoury PR, Morrison JA . The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. Pediatrics 1997; 99: 804–807.

    Article  CAS  Google Scholar 

  33. Fergusson D, Aaron SD, Guyatt G, Hebert P . Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis. BMJ 2002; 325: 652–654.

    Article  PubMed Central  Google Scholar 

  34. SAS/STAT. Guide for Personal Computers, version 91. Cary: NC: SAS Institute, 2004.

  35. Kuss O . How to use SAS for logistic regression with correlated data SAS Users Group 27th Annual SAS Users Group International Conference or SUGI 27, Paper 2002; 261–327.

  36. Simonetti D’Arca A, Tarsitani G, Cairella M, Siani V, De Filippis S, Mancinelli S et al. Prevention of obesity in elementary and nursery school children. Public Health 1986; 100: 166–173.

    Article  Google Scholar 

  37. Dwyer T, Coonan WE, Leitch DR, Hetzel BS, Baghurst RA . An investigation of the effects of daily physical activity on the health of primary school students in South Australia. Int J Epidemiol 1983; 12: 308–313.

    Article  CAS  Google Scholar 

  38. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB . Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr 1996; 128: 797–805.

    Article  CAS  Google Scholar 

  39. Mcmurray RG, Harrell JS, Bangdiwala SI, Bradley CB, Deng S, Levine A . A school-based intervention can reduce body fat and blood pressure in young adolescents. J Adolesc Health 2002; 31: 125–132.

    Article  Google Scholar 

  40. Rodgers DV, Johnson SR, Tschann JM, Chesterman EA, Mellin LM . The evaluation of a school-based obesity prevention program among fourth grade students. In: Balboa Publishing Corporation (ed). Research. Just For Kids! 2001, URL http://www.just-for-kids.org/links.htm (access November 2006).

  41. Vandongen R, Jenner DA, Thompson C, Taggart AC, Spickett EE, Burke V et al. A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children. Prev Med 1995; 24: 9–22.

    Article  CAS  Google Scholar 

  42. Kain J, Uauy R, Albala Vio F, Cerda R, Leyton B . School-based obesity prevention in Chilean primary school children: methodology and evaluation of a controlled study. Int J Obes Relat Metab Disord 2004; 28: 483–493.

    Article  CAS  Google Scholar 

  43. Sallis JF, McKenzie TL, Conway TL, Elder JP, Prochaska JJ, Brown M et al. Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. Am J Prev Med 2003; 24: 209–217.

    Article  Google Scholar 

  44. Flores R . Dance for health: improving fitness in African American and Hispanic adolescents. Public Health Rep 1995; 110: 189–193.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S et al. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet 2006; 368: 299–304.

    Article  Google Scholar 

  46. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003; 290: 2277–2283.

    Article  CAS  Google Scholar 

  47. Bao W, Srinivasan SR, Wattigney WA, Berenson GS . Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bogalusa Heart Study. Arch Intern Med 1994; 154: 1842–1847.

    Article  CAS  Google Scholar 

  48. Byers T . On the hazards of seeing the world through intervention-colored glasses. Am J Clin Nutr 2003; 78: 904–905.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the schools, families and children for their enthusiastic participation in the study. This study was funded mainly by La Consejería de Sanidad de Castilla-La Mancha (grant GC03060-00). Additional funding was obtained from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Red de Investigación en Actividades Preventivas y de Promoción de Salud (grant RD06/0018/0038). VMV was the principal researcher and guarantor. VMV and FSA designed the study, together with FRA who helped to refine the study design. VMV and FSA coordinated data collection. RFG and SSM made biochemical determinations. MSL designed and coordinated the implementation of the physical activity program. MSM and ELG conducted statistical analysis, and all the authors contributed to the interpretation of results. VMV and FRA drafted the paper and all the authors critically reviewed it for scientific content and approved the final version.

Author information

Authors and Affiliations

  1. Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain

    V Martínez Vizcaíno, M Solera Martínez & M Sánchez López

  2. Family and Community Medicine Teaching Unit, Servicio de Salud de Castilla-La Mancha, Cuenca, Spain

    F Salcedo Aguilar

  3. Clinical Analysis Laboratory, Hospital Virgen de la Luz, Cuenca, Spain

    R Franquelo Gutiérrez & S Serrano Martínez

  4. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    E López García & F Rodríguez Artalejo

  5. CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    E López García & F Rodríguez Artalejo

Authors
  1. V Martínez Vizcaíno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Salcedo Aguilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Franquelo Gutiérrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Solera Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Sánchez López
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Serrano Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E López García
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F Rodríguez Artalejo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V Martínez Vizcaíno.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martínez Vizcaíno, V., Salcedo Aguilar, F., Franquelo Gutiérrez, R. et al. Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial. Int J Obes 32, 12–22 (2008). https://doi.org/10.1038/sj.ijo.0803738

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0803738

Keywords

This article is cited by

Search

Advanced search

Quick links