Long-term effect of a school-based physical activity program (KISS) on fitness and adiposity in children: a cluster-randomized controlled trial.
BACKGROUND
School-based intervention studies promoting a healthy lifestyle have shown favorable immediate health effects. However, there is a striking paucity on long-term follow-ups. The aim of this study was therefore to assess the 3 yr-follow-up of a cluster-randomized controlled school-based physical activity program over nine month with beneficial immediate effects on body fat, aerobic fitness and physical activity.


RESULTS
Initially, 28 classes from 15 elementary schools in Switzerland were grouped into an intervention (16 classes from 9 schools, n = 297 children) and a control arm (12 classes from 6 schools, n = 205 children) after stratification for grade (1st and 5th graders). Three years after the end of the multi-component physical activity program of nine months including daily physical education (i.e. two additional lessons per week on top of three regular lessons), short physical activity breaks during academic lessons, and daily physical activity homework, 289 (58%) participated in the follow-up. Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). After adjustment for grade, gender, baseline value and clustering within classes, children in the intervention arm compared with controls had a significantly higher average level of aerobic fitness at follow-up (0.373 z-score units [95%-CI: 0.157 to 0.59, p = 0.001] corresponding to a shift from the 50th to the 65th percentile between baseline and follow-up), while the immediate beneficial effects on the other primary outcomes were not sustained.


CONCLUSIONS
Apart from aerobic fitness, beneficial effects seen after one year were not maintained when the intervention was stopped. A continuous intervention seems necessary to maintain overall beneficial health effects as reached at the end of the intervention.


BACKGROUND
ControlledTrials.com ISRCTN15360785.
Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland ; Department of Human Movement Science, Maastricht University, Maastricht, The Netherlands.
Ursina
U
Meyer
Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
Christian
C
Schindler
Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland.
Lukas
L
Zahner
Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
Dominique
D
Ernst
University Children's Hospital Würzburg, Wuerzburg, Germany.
Helge
H
Hebestreit
Department of Public and Occupational Health and EMGO+ Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Willem
W
van Mechelen
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Hans-Peter
HP
Brunner-La Rocca
Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
Nicole
N
Probst-Hensch
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Jardena J
JJ
Puder
Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland ; Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudoise, University of Lausanne, Lausanne, Switzerland.
Susi
S
Kriemler
D050154:Adiposity / Q000502:physiology*; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D011379:Prognosis; D012572:School Health Services; D011795:Surveys and Questionnaires; D013557:Switzerland