Does an internet-based intervention for teachers improve children’s cardiorespiratory fitness when delivered across a large number of schools?
In this cluster randomized clinical trial of 22 schools including 1188 students, use of the internet-based intervention significantly improved children’s cardiorespiratory fitness at 12 months. Follow-up assessments at 24 months showed a sustained effect.
Results of this randomized clinical trial suggest that the intervention has potential to be scaled to benefit children’s health at a population level.
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.
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.
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.
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.
http://anzctr.org.au Identifier: ACTRN12616000731493
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Lonsdale C, Sanders T, Parker P, et al. Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children: A Cluster Randomized Clinical Trial. JAMA Pediatr. Published online May 03, 2021. doi:10.1001/jamapediatrics.2021.0417
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