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

Hartwig, Timothy Bryan and Sanders, Taren and Vasconcellos, Diego and Noetel, Michael and Parker, Philip D. and Lubans, David Revalds and Andrade, Susana and Ávila-García, Manuel and Bartholomew, John and Belton, Sarahjane and Brooks, Naomi E. and Bugge, Anna and Cavero-Redondo, Iván and Christiansen, Lars Breum and Cohen, Kristen and Coppinger, Tara and Dyrstad, Sindre and Errisuriz, Vanessa and Fairclough, Stuart and Gorely, Trish and Javier Huertas-Delgado, Francisco and Issartel, Johann and Kriemler, Susi and Kvalø, Silje Eikanger and Marques-Vidal, Pedro and Martinez-Vizcaino, Vicente and Møller, Niels Christian and Moran, Colin and Morris, John and Nevill, Mary and Ochoa-Avilés, Angélica and O'Leary, Mai and Peralta, Louisa and Pfeiffer, Karin A. and Puder, Jardena and Redondo-Tébar, Andrés and Robbins, Lorraine B. and Sanchez-Lopez, Mairena and Tarp, Jakob and Taylor, Sarah and Tercedor, Pablo and Toftager, Mette and Villa-González, Emilio and Wedderkopp, Niels and Weston, Kathryn Louise and Yin, Zenong and Zhixiong, Zhou and Lonsdale, Chris and Del Pozo Cruz, Borja (2021) 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, 55 (13). pp. 721-729. ISSN 1473-0480 (https://doi.org/10.1136/bjsports-2020-102740)

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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 2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. 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.

ORCID iDs

Hartwig, Timothy Bryan, Sanders, Taren, Vasconcellos, Diego, Noetel, Michael, Parker, Philip D., Lubans, David Revalds, Andrade, Susana, Ávila-García, Manuel, Bartholomew, John, Belton, Sarahjane, Brooks, Naomi E., Bugge, Anna, Cavero-Redondo, Iván, Christiansen, Lars Breum, Cohen, Kristen, Coppinger, Tara, Dyrstad, Sindre, Errisuriz, Vanessa, Fairclough, Stuart, Gorely, Trish, Javier Huertas-Delgado, Francisco, Issartel, Johann, Kriemler, Susi, Kvalø, Silje Eikanger, Marques-Vidal, Pedro, Martinez-Vizcaino, Vicente, Møller, Niels Christian, Moran, Colin, Morris, John, Nevill, Mary, Ochoa-Avilés, Angélica, O'Leary, Mai, Peralta, Louisa, Pfeiffer, Karin A., Puder, Jardena, Redondo-Tébar, Andrés, Robbins, Lorraine B., Sanchez-Lopez, Mairena, Tarp, Jakob, Taylor, Sarah, Tercedor, Pablo, Toftager, Mette, Villa-González, Emilio, Wedderkopp, Niels, Weston, Kathryn Louise ORCID logoORCID: https://orcid.org/0000-0001-5918-6389, Yin, Zenong, Zhixiong, Zhou, Lonsdale, Chris and Del Pozo Cruz, Borja;
CORE (COnnecting REpositories)