Chris Lonsdale1, Taren Sanders1, Philip Parker1, Michael Noetel2, Timothy Hartwig3, Diego Vasconcellos1, Jane Lee1, Devan Antczak1, Morwenna Kirwan4, Philip Morgan5, Jo Salmon6, Marj Moodie7, Heather McKay8, Andrew Bennie9, Ronald C Plotnikoff5, Renata Cinelli10, David Greene3, Louisa Peralta11, Dylan Cliff12, Gregory Kolt9, Jennifer Gore13, Lan Gao14, James Boyer15, Ross Morrison15, Charles Hillman16, Tatsuya T Shigeta16, Elise Tan7, David R Lubans5. 1. Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia. 2. School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, Australia. 3. School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, New South Wales, Australia. 4. Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia. 5. Priority Research Centre for Physical Activity and Nutrition, Callaghan, University of Newcastle, New South Wales, Australia. 6. Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia. 7. Global Obesity Centre, Deakin University, Burwood, Victoria, Australia. 8. Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada. 9. School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia. 10. National School of Education, Australian Catholic University, Strathfield, New South Wales, Australia. 11. School of Education and Social Work, Sydney University, Camperdown, New South Wales, Australia. 12. School of Education, University of Wollongong, Wollongong, New South Wales, Australia. 13. School of Education, University of Newcastle, Callaghan, New South Wales, Australia. 14. School of Health and Social Development, Deakin University, Burwood, Victoria, Australia. 15. New South Wales Department of Education, Turrella, New South Wales, Australia. 16. Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts.
Abstract
Importance: Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective: To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. Design, Setting, and Participants: In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. Interventions: The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). Main Outcomes and Measures: Multistage 20-m shuttle run test for cardiorespiratory fitness. Results: Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). Conclusions and Relevance: In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. Trial Registration: http://anzctr.org.au Identifier: ACTRN12616000731493.
Importance: Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective: To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. Design, Setting, and Participants: In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. Interventions: The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). Main Outcomes and Measures: Multistage 20-m shuttle run test for cardiorespiratory fitness. Results: Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). Conclusions and Relevance: In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. Trial Registration: http://anzctr.org.au Identifier: ACTRN12616000731493.
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