Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial

Abstract

Objective: To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children.

Design: Cluster randomised controlled single blinded trial (Ballabeina study) over one school year; randomisation was performed after stratification for linguistic region.

Setting: 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerland.

Participants: 652 of the 727 preschool children had informed consent and were present for baseline measures (mean age 5.1 years (SD 0.7), 72% migrants of multicultural origins). No children withdrew, but 26 moved away.

Intervention: The multidimensional culturally tailored lifestyle intervention included a physical activity programme, lessons on nutrition, media use (use of television and computers), and sleep and adaptation of the built environment of the preschool class. It lasted from August 2008 to June 2009.

Main outcome measures: Primary outcomes were aerobic fitness (20 m shuttle run test) and body mass index (BMI). Secondary outcomes included motor agility, balance, percentage body fat, waist circumference, physical activity, eating habits, media use, sleep, psychological health, and cognitive abilities.

Results: Compared with controls, children in the intervention group had an increase in aerobic fitness at the end of the intervention (adjusted mean difference: 0.32 stages (95% confidence interval 0.07 to 0.57; P=0.01) but no difference in BMI (-0.07 kg/m(2), -0.19 to 0.06; P=0.31). Relative to controls, children in the intervention group had beneficial effects in motor agility (-0.54 s, -0.90 to -0.17; P=0.004), percentage body fat (-1.1%, -2.0 to -0.2; P=0.02), and waist circumference (-1.0 cm, -1.6 to -0.4; P=0.001). There were also significant benefits in the intervention group in reported physical activity, media use, and eating habits, but not in the remaining secondary outcomes.

Conclusions: A multidimensional intervention increased aerobic fitness and reduced body fat but not BMI in predominantly migrant preschool children. Trial registration Clinical Trials NCT00674544.

Fig 1 Trial profile of clusters. Inclusion criteria were >40% prevalence of migrant children and no participation in any other prevention project. Reasons for refusals were lack of interest or time (of director or teacher) or health problems of teacher

Fig 2 Trial profile of participants. *BMI at follow-up also measured in four control and one intervention child who had moved away; †bioelectrical impedance analysis; ‡measured by accelerometry; §attention and spatial working memory; ¶reported physical activity, sleep duration, and media use; **assessed with parental questionnaires; ††completed all questions related to five recommendations of Swiss Society of Nutrition (used to calculate sum score). One child with cerebral palsy was excluded from fitness testing