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Randomized Controlled Trial
. 2016 Nov 24;6(11):e010957.
doi: 10.1136/bmjopen-2015-010957.

Long-term Effects of the Active for Life Year 5 (AFLY5) School-Based Cluster-Randomised Controlled Trial

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Free PMC article
Randomized Controlled Trial

Long-term Effects of the Active for Life Year 5 (AFLY5) School-Based Cluster-Randomised Controlled Trial

Emma L Anderson et al. BMJ Open. .
Free PMC article

Abstract

Objective: To investigate the long-term effectiveness of a school-based intervention to improve physical activity and diet in children.

Design: Cluster-randomised controlled trial.

Setting: 60 primary schools in the southwest of England.

Participants: Primary school children who were aged 8-9 years at recruitment, 9-10 years during the intervention and 10-11 years at the long-term follow-up assessment.

Intervention: Teacher training, provision of lesson and child-parent interactive homework plans and teaching materials.

Main outcome measures: Primary outcomes were accelerometer-assessed minutes of moderate to vigorous physical activity (MVPA) per day, accelerometer-assessed minutes of sedentary behaviour per day and reported daily consumption of servings of fruit and vegetables.

Results: 60 schools with 2221 eligible children were recruited. As in the previously published assessment immediately after the end of the intervention, none of the three primary outcomes differed between children in schools allocated to the intervention, compared with those in control schools at the end of the long-term follow-up (1 year after the end of the intervention). Differences in secondary outcomes were consistent with those at the immediate follow-up, with no evidence that these had diminished over time. Comparing intervention with control schools, the difference in mean child-reported screen viewing at the weekend was -16.03 min (95% CI -32.82 to 0.73), for servings of snacks per day, the difference was -0.11 (95% CI -0.39 to 0.06), in servings of high-energy drinks per day -0.20 (95% CI -0.39 to -0.01) and in servings of high-fat foods per day -0.12 (95% CI -0.39 to 0.00). None of these reached our predefined level of statistical significance, especially after accounting for multiple testing.

Conclusions: School-based curriculum interventions alone are unlikely to have a major public health impact on children's diet and physical activity.

Trial registration number: ISRCTN50133740, Post-results.

Keywords: children; diet; physical activity; randomised controlled trial; schools.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Trial profile. Np, number of participants (school pupils). No schools withdrew from the study, so all randomised units are present at baseline and at both follow-up assessments. Percentages for proportions of children with each measurement at baseline and at follow-ups are of total number of children who were pupils in randomised schools at baseline. Not all pupils with follow-up measures necessarily had data on the same measure at baseline (or vice versa), because of different pupils being absent at baseline and follow-up assessments at each time point, and because of pupils leaving or moving between schools. In all analyses, study participants were analysed in the group (intervention or control) to which they were randomised.
Figure 2
Figure 2
Difference in means and ORs for the intervention compared with the control group for the three primary outcomes and nine secondary outcomes, assessed at baseline, first follow-up (conducted immediately after the end of the intervention) and second follow-up (12 months postintervention). (A) Accelerometer-assessed time spent in moderate to vigorous physical activity. (B) Time spent in sedentary behaviour. (C) Servings of fruit and vegetables per day. (D) Time spent screen viewing on weekdays. (E) Time spent screen viewing on Saturdays. (F) Servings of snacks per day. (G) Servings of high-fat foods per day. (H) Servings of high-energy drinks per day. (I) Body mass index z-score (as a continuous variable). (J) Waist circumference z-score (as a continuous variable). (K) General overweight or obesity (based on BMI measurements). (I) Central overweight/obesity based on waist circumference measurements. The figures all show differences in means for continuous variables (graphs A–J) and ORs for binary outcomes (graphs K and L), comparing those in the intervention arm of the trial with those in the control arm (dots), together with 95% CIs (vertical lines with horizontal caps representing the limits). The dashed horizontal lines represent the null values (zero for all differences in means of continuous variables and one for ORs of binary outcomes).

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