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Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (Ballabeina): study design of a cluster randomized controlled trial

Niederer I, Kriemler S, Zahner L, Bürgi F, Ebenegger V, Hartmann T, Meyer U, Schindler C, Nydegger A, Marques-Vidal P, Puder JJ - BMC Public Health (2009)

Bottom Line: In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing.The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behaviour, and to reduce media use.Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test).

Affiliation: Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland. iris.niederer@unibas.ch

ABSTRACT

Background: Childhood obesity and physical inactivity are increasing dramatically worldwide. Children of low socioeconomic status and/or children of migrant background are especially at risk. In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing. A special gap exists for younger children and in high risk groups.

Methods/design: This paper describes the rationale, design, curriculum, and evaluation of a multicenter preschool randomized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons. Twenty preschool classes in the German (canton St. Gallen) and another 20 in the French (canton Vaud) part of Switzerland were separately selected and randomized to an intervention and a control arm by the use of opaque envelopes. The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behaviour, and to reduce media use. According to the ecological model, it included children, their parents and the teachers. The regular teachers performed the majority of the intervention and were supported by a local health promoter. The intervention included physical activity lessons, adaptation of the built infrastructure; promotion of regional extracurricular physical activity; playful lessons about nutrition, media use and sleep, funny homework cards and information materials for teachers and parents. It lasted one school year. Baseline and post-intervention evaluations were performed in both arms. Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test). Secondary outcomes included total (skinfolds, bioelectrical impedance) and central (waist circumference) body fat, motor abilities (obstacle course, static and dynamic balance), physical activity and sleep duration (accelerometry and questionnaires), nutritional behaviour and food intake, media use, quality of life and signs of hyperactivity (questionnaires), attention and spatial working memory ability (two validated tests). Researchers were blinded to group allocation.

Discussion: The purpose of this paper is to outline the design of a school-based multicenter cluster randomized, controlled trial aiming to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerland with a high migrant population.

Trial registration: Trial Registration: (clinicaltrials.gov) NCT00674544.

Ecological Model. Bronfenbrenner's Ecological Model describing the environmental influences on a child, with permission from [39].
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Figure 1: Ecological Model. Bronfenbrenner's Ecological Model describing the environmental influences on a child, with permission from [39].

Mentions: Causes for overweight and obesity are multifaceted and prevention is difficult and complex. In the last years, social models of health promotion have been increasingly used to study complex interactions [36,37], as simple interventions are unlikely to work on their own and the development of effective preventive interventions requires strategies that affect multiple settings simultaneously [38]. Ballabeina is based on the social ecological model [36] (figure 1), that includes concentric rings that influence lifestyle patterns. The "psychobiologic core" of the model represents the genetic, physiologic, and socio-cultural forces that shape ones identity (individual child). This core is surrounded by the microsystem, the immediate environments with which a child interacts (parents, siblings, teachers, peers, etc.). The exosystem includes environments with which the child doesn't usually directly interact, but that can still affect the child (school boards, etc.). The macrosystem includes the broad societal settings under which the other cycles function (culture, history, social norms, economic system, etc.). For preschooler, the two main influence factors are the family and the teachers [39]. That's why the main intervention targets included these settings. The program promotes a healthy lifestyle by positively influencing personal, behavioral, and environmental factors. On the one side the intervention program transferred knowledge about adequate PA, nutrition and healthy food selection, reduced media use and proper sleep. On the other side the intervention also seeked to change the behavior of the child by increasing skills like motor abilities and augmenting daily PA. In addition the children and parents learned in a practical way strategies to change their nutritional behavior according to five nutrition messages (see below). The teachers achieved competencies by implementing PA and nutrition lessons in the preschool. On the environmental level, the built infrastructure (in- and outdoor in preschool) was adapted to enhance the child's natural behaviour to move and to explore. Participation of the children in extracurricular sport activities (club, etc.) in their neighbourhoods was promoted. The Ballabeina team also collaborated with the school boards, the building authorities and the school health services.

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Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (Ballabeina): study design of a cluster randomized controlled trial

Niederer I, Kriemler S, Zahner L, Bürgi F, Ebenegger V, Hartmann T, Meyer U, Schindler C, Nydegger A, Marques-Vidal P, Puder JJ - BMC Public Health (2009)

Ecological Model. Bronfenbrenner's Ecological Model describing the environmental influences on a child, with permission from [39].
© Copyright Policy
Figure 1: Ecological Model. Bronfenbrenner's Ecological Model describing the environmental influences on a child, with permission from [39].
Mentions: Causes for overweight and obesity are multifaceted and prevention is difficult and complex. In the last years, social models of health promotion have been increasingly used to study complex interactions [36,37], as simple interventions are unlikely to work on their own and the development of effective preventive interventions requires strategies that affect multiple settings simultaneously [38]. Ballabeina is based on the social ecological model [36] (figure 1), that includes concentric rings that influence lifestyle patterns. The "psychobiologic core" of the model represents the genetic, physiologic, and socio-cultural forces that shape ones identity (individual child). This core is surrounded by the microsystem, the immediate environments with which a child interacts (parents, siblings, teachers, peers, etc.). The exosystem includes environments with which the child doesn't usually directly interact, but that can still affect the child (school boards, etc.). The macrosystem includes the broad societal settings under which the other cycles function (culture, history, social norms, economic system, etc.). For preschooler, the two main influence factors are the family and the teachers [39]. That's why the main intervention targets included these settings. The program promotes a healthy lifestyle by positively influencing personal, behavioral, and environmental factors. On the one side the intervention program transferred knowledge about adequate PA, nutrition and healthy food selection, reduced media use and proper sleep. On the other side the intervention also seeked to change the behavior of the child by increasing skills like motor abilities and augmenting daily PA. In addition the children and parents learned in a practical way strategies to change their nutritional behavior according to five nutrition messages (see below). The teachers achieved competencies by implementing PA and nutrition lessons in the preschool. On the environmental level, the built infrastructure (in- and outdoor in preschool) was adapted to enhance the child's natural behaviour to move and to explore. Participation of the children in extracurricular sport activities (club, etc.) in their neighbourhoods was promoted. The Ballabeina team also collaborated with the school boards, the building authorities and the school health services.

Bottom Line: In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing.The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behaviour, and to reduce media use.Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test).

Affiliation: Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland. iris.niederer@unibas.ch

ABSTRACT

Background:

Background: Childhood obesity and physical inactivity are increasing dramatically worldwide. Children of low socioeconomic status and/or children of migrant background are especially at risk. In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing. A special gap exists for younger children and in high risk groups.

Methods/design: This paper describes the rationale, design, curriculum, and evaluation of a multicenter preschool randomized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons. Twenty preschool classes in the German (canton St. Gallen) and another 20 in the French (canton Vaud) part of Switzerland were separately selected and randomized to an intervention and a control arm by the use of opaque envelopes. The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behaviour, and to reduce media use. According to the ecological model, it included children, their parents and the teachers. The regular teachers performed the majority of the intervention and were supported by a local health promoter. The intervention included physical activity lessons, adaptation of the built infrastructure; promotion of regional extracurricular physical activity; playful lessons about nutrition, media use and sleep, funny homework cards and information materials for teachers and parents. It lasted one school year. Baseline and post-intervention evaluations were performed in both arms. Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test). Secondary outcomes included total (skinfolds, bioelectrical impedance) and central (waist circumference) body fat, motor abilities (obstacle course, static and dynamic balance), physical activity and sleep duration (accelerometry and questionnaires), nutritional behaviour and food intake, media use, quality of life and signs of hyperactivity (questionnaires), attention and spatial working memory ability (two validated tests). Researchers were blinded to group allocation.

Discussion: The purpose of this paper is to outline the design of a school-based multicenter cluster randomized, controlled trial aiming to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerland with a high migrant population.

Trial registration: Trial Registration: (clinicaltrials.gov) NCT00674544.

View Similar Images In: Results  - Collection
View Article: Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2676270&rFormat=json&query=null&req=5