School-based physical activity interventions in children: success or failure?
Wednesday, January 21, 2009
On Monday, I posted on the ‘Muscle Beach’ for kids that I saw in Eilat, Israel, and suggested, a bit tongue-in-cheek, that having such facilities in Canada and the US may be the cure for the childhood obesity epidemic. This post led to a good discussion in the ‘Comments’ section from some of our loyal readers, particularly, Dr. Yoni Freedhoff (read here).
One of the more salient issues to arise from our discussion, was the notion that, as I stated, “the focus on weight as the primary outcome in lifestyle based obesity interventions is myopic and misguided. Individuals of all sizes, and ages, can vastly improve their health without a noticeable budge in their scale weight.” This is an issue I have previously blogged about, and have published a couple papers on (See: Can. J. Cardiol. or APNM). I feel very strongly that in lifestyle-based obesity interventions, we need to shift the focus from the outcome (i.e. weight) to the healthy behavior (i.e. balanced diet and physical activity) to have any chance of long-term lifestyle change.
Serendipitously, I just came across a ‘hot-off-the-press’ Cochrane review on the effectiveness of school- based physical activity interventions in children, which nicely supports these concerns. As a means of quick background, Cochrane reviews are some of the most meticulous and rigorous systematic reviews published on a variety of health topics. These reviews are conducted by a group of over 11 000 expert volunteers in more than 90 countries, and consider only the results of high quality randomized-controlled trials.
In the aforementioned review, a total of 26 randomized-controlled studies were reviewed. Overall, school-based physical activity promotion programs were unfortunately not shown to have a significant impact on body-mass index (a crude marker of obesity). Thus, if this was our only gauge of treatment success, we would quickly conclude that school-based physical activity programs are useless (as did this short-sighted article in Newsweek, entitled, “Childhood Obesity and School Exercise Programs: Not So Fast”). However, despite no effect on BMI, these interventions did have a significant beneficial effect on blood cholesterol levels and cardiovascular fitness (the importance of which I have previously discussed). Also, these interventions were shown to increase overall physical activity levels and decrease TV viewing time among participating children. So, not useless after all.
Thus, as Yoni and I agreed, we are better off promoting physical activity for general health rather than weight-reduction in the hopes of producing long-term lifestyle change in children as in adults.
Peter
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Anonymous Said,
Peter I just wanted to let you know how much I am enjoying your and Travis' blog. I receive email notifications and often times forward these to everyone here in the Healthy Living Unit at the Public Health Agency of Canada.
Your summaries are both entertaining and succinct and are helpful for those of us who are so busy that we can't keep up with the most recent research as quickly. Just want you to know that your ideas and research are reaching physical activity policy makers in the federal government. Keep it up!
Katie
Posted on January 23, 2009 9:54 AM
Peter Janiszewski, PhD (Cand.), MSc Said,
Great to hear from you Katie! Thank you so much for the encouraging comments. The original reason we started the blog was to get our message heard by people outside of academia. I started getting frustrated by the fact that no matter how many papers I write, the end result will be abysmal unless people become aware of the existence of that research. Thus, I can't express how glad I am to hear that finally we may be having an influence on people in a position, such as yourself, who can implement what we do and produce real changes in society.
Thanks and take care,
Peter
Posted on January 23, 2009 10:44 AM
Travis Saunders, MSc Said,
Thanks for the positive message Katie!
Posted on January 23, 2009 11:24 AM