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Randomized Controlled Trial
. 2019 Jan 15;16(2):232.
doi: 10.3390/ijerph16020232.

Effect of a Multidimensional Physical Activity Intervention on Body Mass Index, Skinfolds and Fitness in South African Children: Results from a Cluster-Randomised Controlled Trial

Ivan Müller  1   2   3 , Christian Schindler  4   5 , Larissa Adams  6 , Katharina Endes  7 , Stefanie Gall  8 , Markus Gerber  9 , Nan S N Htun  10   11 , Siphesihle Nqweniso  12 , Nandi Joubert  13 , Nicole Probst-Hensch  14   15 , Rosa du Randt  16 , Harald Seelig  17 , Danielle Smith  18 , Peter Steinmann  19   20 , Jürg Utzinger  21   22 , Peiling Yap  23   24   25 , Cheryl Walter  26 , Uwe Pühse  27
Affiliations
Randomized Controlled Trial

Effect of a Multidimensional Physical Activity Intervention on Body Mass Index, Skinfolds and Fitness in South African Children: Results from a Cluster-Randomised Controlled Trial

Ivan Müller et al. Int J Environ Res Public Health. .

Abstract

Obesity-related conditions impose a considerable and growing burden on low- and middle-income countries, including South Africa. We aimed to assess the effect of twice a 10-week multidimensional, school-based physical activity intervention on children's health in Port Elizabeth, South Africa. A cluster-randomised controlled trial was implemented from February 2015 to May 2016 in grade 4 classes in eight disadvantaged primary schools. Interventions consisted of physical education lessons, moving-to-music classes, in-class activity breaks and school infrastructure enhancement to promote physical activity. Primary outcomes included cardiorespiratory fitness, body mass index (BMI) and skinfold thickness. Explanatory variables were socioeconomic status, self-reported physical activity, stunting, anaemia and parasite infections. Complete data were available from 746 children. A significantly lower increase in the mean BMI Z-score (estimate of difference in mean change: -0.17; 95% confidence interval (CI): -0.24 to -0.09; p < 0.001) and reduced increase in the mean skinfold thickness (difference in mean change: -1.06; 95% CI: -1.83 to -0.29; p = 0.007) was observed in intervention schools. No significant group difference occurred in the mean change of cardiorespiratory fitness (p > 0.05). These findings show that a multidimensional, school-based physical activity intervention can reduce the increase in specific cardiovascular risk factors. However, a longer and more intensive intervention might be necessary to improve cardiorespiratory fitness.

Keywords: South Africa; body mass index; cardiorespiratory fitness; intestinal protozoa; physical activity programme; school-aged children; soil-transmitted helminths.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Figure 1
Figure 1
Selection of intervention sites (schools) for the ’Disease, Activity and Schoolchildren’s Health‘ (DASH) study, including flow chart of study participants with detailed information on all intervention arms from the randomisation of schools to the endline assessment of schoolchildren, Port Elizabeth, South Africa, 2015 and 2016.
Figure 2
Figure 2
Timetable and content of the children’s assessments and the multidimensional physical activity intervention programme, Port Elizabeth, South Africa in 2015 and 2016. The total duration of physical activity for schools with physical activity intervention was 55 h, compared to 15 h for schools without physical activity intervention.
Figure 3
Figure 3
Estimated intervention effects on VO2 max, sex- and age-adjusted Z-score of body mass index (BMI) and thickness of skinfolds in different strata of children from baseline (February 2015) to 16-month endline (May 2016). Intervention effects were defined as differences in the mean longitudinal changes of the respective outcomes associated with the physical activity intervention.
See this image and copyright information in PMC

Comment in

  • JPEN Journal Club 45. Cluster Randomization.
    Koretz RL. Koretz RL. JPEN J Parenter Enteral Nutr. 2019 Sep;43(7):941-943. doi: 10.1002/jpen.1598. Epub 2019 Apr 22. JPEN J Parenter Enteral Nutr. 2019. PMID: 31006871 No abstract available.

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