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Published in: BMC Pediatrics 1/2013

Open Access 01-12-2013 | Research article

Effect of four additional physical education lessons on body composition in children aged 8–13 years – a prospective study during two school years

Authors: Heidi Klakk, Mai Chinapaw, Malene Heidemann, Lars Bo Andersen, Niels Wedderkopp

Published in: BMC Pediatrics | Issue 1/2013

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Abstract

Background

Strategies for combating increasing childhood obesity is called for. School settings have been pointed out as potentially effective settings for prevention. The objective of this paper was to evaluate the effect of four additional Physical Education (PE) lessons/week in primary schools on body composition and weight status in children aged 8–13.

Methods

Children attending 2nd to 4th grade (n = 632) in 10 public schools, 6 intervention and 4 control schools, participated in this longitudinal study during 2 school years. Outcome measures: Primary: Body Mass Index (BMI) and Total Body Fat percentage (TBF%) derived from Dual Energy X ray Absorptiometry (DXA). Secondary: the moderating effect of overweight/obesity (OW/OB) and adiposity based on TBF% cut offs for gender.

Results

Intervention effect on BMI and TBF% (BMI: β -0.14, 95% CI: -0.33; 0.04, TBF%: β -0.08, 95% CI:-0.65;0.49) was shown insignificant. However, we found significant beneficial intervention effect on prevalence of OW/OB based on BMI (OR 0.29, 95% CI: 0.11;0.72). The intervention effect on adiposity based on TBF% cut offs was borderline significant (OR 0.64, 95% CI:0. 39; 1.05).

Conclusion

Four additional PE lessons/week at school can significantly improve the prevalence of OW/OB in primary schoolchildren. Mean BMI and TBF% improved in intervention schools, but the difference with controls was not significant. The intervention had a larger effect in children who were OW/OB or adipose at baseline.
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Literature
1.
go back to reference Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, Kelnar CJ: Health consequences of obesity. Arch Dis Child. 2003, 88 (9): 748-752. 10.1136/adc.88.9.748.CrossRefPubMedPubMedCentral Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, Kelnar CJ: Health consequences of obesity. Arch Dis Child. 2003, 88 (9): 748-752. 10.1136/adc.88.9.748.CrossRefPubMedPubMedCentral
2.
go back to reference Baker JL, Olsen LW, Sorensen TI: Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007, 357 (23): 2329-2337. 10.1056/NEJMoa072515.CrossRefPubMedPubMedCentral Baker JL, Olsen LW, Sorensen TI: Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007, 357 (23): 2329-2337. 10.1056/NEJMoa072515.CrossRefPubMedPubMedCentral
3.
go back to reference Hills AP, Andersen LB, Byrne NM: Physical activity and obesity in children. Br J Sports Med. 2011, 45 (11): 866-870. 10.1136/bjsports-2011-090199.CrossRefPubMed Hills AP, Andersen LB, Byrne NM: Physical activity and obesity in children. Br J Sports Med. 2011, 45 (11): 866-870. 10.1136/bjsports-2011-090199.CrossRefPubMed
4.
go back to reference Hills AP, Okely AD, Baur LA: Addressing childhood obesity through increased physical activity. Nat Rev Endocrinol. 2010, 6 (10): 543-549.PubMed Hills AP, Okely AD, Baur LA: Addressing childhood obesity through increased physical activity. Nat Rev Endocrinol. 2010, 6 (10): 543-549.PubMed
5.
go back to reference Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D: School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst Rev. 2009, 1: CD007651-PubMed Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D: School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst Rev. 2009, 1: CD007651-PubMed
6.
go back to reference Harris KC, Kuramoto LK, Schulzer M, Retallack JE: Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009, 180 (7): 719-726. 10.1503/cmaj.080966.CrossRefPubMedPubMedCentral Harris KC, Kuramoto LK, Schulzer M, Retallack JE: Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009, 180 (7): 719-726. 10.1503/cmaj.080966.CrossRefPubMedPubMedCentral
7.
go back to reference Shaya FT, Flores D, Gbarayor CM, Wang J: School-based obesity interventions: a literature review. J Sch Health. 2008, 78 (4): 189-196. 10.1111/j.1746-1561.2008.00285.x.CrossRefPubMed Shaya FT, Flores D, Gbarayor CM, Wang J: School-based obesity interventions: a literature review. J Sch Health. 2008, 78 (4): 189-196. 10.1111/j.1746-1561.2008.00285.x.CrossRefPubMed
8.
go back to reference Pearson S, Hansen B, Sorensen TI, Baker JL: Overweight and obesity trends in Copenhagen schoolchildren from 2002 to 2007. Acta Paediatr. 2010, 99 (11): 1675-1678. 10.1111/j.1651-2227.2010.01897.x.CrossRefPubMed Pearson S, Hansen B, Sorensen TI, Baker JL: Overweight and obesity trends in Copenhagen schoolchildren from 2002 to 2007. Acta Paediatr. 2010, 99 (11): 1675-1678. 10.1111/j.1651-2227.2010.01897.x.CrossRefPubMed
9.
go back to reference Rokholm B, Baker JL, Sorensen TI: The levelling off of the obesity epidemic since the year 1999–a review of evidence and perspectives. Obes Rev. 2010, 11 (12): 835-846. 10.1111/j.1467-789X.2010.00810.x.CrossRefPubMed Rokholm B, Baker JL, Sorensen TI: The levelling off of the obesity epidemic since the year 1999–a review of evidence and perspectives. Obes Rev. 2010, 11 (12): 835-846. 10.1111/j.1467-789X.2010.00810.x.CrossRefPubMed
10.
go back to reference Sorensen TI, Due P, Hansen B, Heitmann BL, Jorgensen K, Lichtenberg A, Michaelsen KF, Muller P, Richelsen B: [Monitoring the prevalence of obesity]. Ugeskrift for laeger. 2008, 170 (5): 317-320.PubMed Sorensen TI, Due P, Hansen B, Heitmann BL, Jorgensen K, Lichtenberg A, Michaelsen KF, Muller P, Richelsen B: [Monitoring the prevalence of obesity]. Ugeskrift for laeger. 2008, 170 (5): 317-320.PubMed
11.
go back to reference Matthiessen J, Velsing Groth M, Fagt S, Biltoft-Jensen A, Stockmarr A, Andersen JS, Trolle E: Prevalence and trends in overweight and obesity among children and adolescents in Denmark. Scand J Public Health. 2008, 36 (2): 153-160. 10.1177/1403494807085185.CrossRefPubMed Matthiessen J, Velsing Groth M, Fagt S, Biltoft-Jensen A, Stockmarr A, Andersen JS, Trolle E: Prevalence and trends in overweight and obesity among children and adolescents in Denmark. Scand J Public Health. 2008, 36 (2): 153-160. 10.1177/1403494807085185.CrossRefPubMed
12.
go back to reference Lindsay RS, Hanson RL, Roumain J, Ravussin E, Knowler WC, Tataranni PA: Body mass index as a measure of adiposity in children and adolescents: relationship to adiposity by dual energy x-ray absorptiometry and to cardiovascular risk factors. J Clin Endocrinol Metab. 2001, 86 (9): 4061-4067. 10.1210/jc.86.9.4061.CrossRefPubMed Lindsay RS, Hanson RL, Roumain J, Ravussin E, Knowler WC, Tataranni PA: Body mass index as a measure of adiposity in children and adolescents: relationship to adiposity by dual energy x-ray absorptiometry and to cardiovascular risk factors. J Clin Endocrinol Metab. 2001, 86 (9): 4061-4067. 10.1210/jc.86.9.4061.CrossRefPubMed
13.
go back to reference Glasser N, Zellner K, Kromeyer-Hauschild K: Validity of body mass index and waist circumference to detect excess fat mass in children aged 7–14 years. Eur J Clin Nutr. 2011, 65 (2): 151-159. 10.1038/ejcn.2010.245.CrossRefPubMed Glasser N, Zellner K, Kromeyer-Hauschild K: Validity of body mass index and waist circumference to detect excess fat mass in children aged 7–14 years. Eur J Clin Nutr. 2011, 65 (2): 151-159. 10.1038/ejcn.2010.245.CrossRefPubMed
14.
go back to reference Freedman DS, Wang J, Thornton JC, Mei Z, Sopher AB, Pierson RN, Dietz WH, Horlick M: Classification of body fatness by body mass index-for-age categories among children. Arch Pediatr Adolesc Med. 2009, 163 (9): 805-811. 10.1001/archpediatrics.2009.104.CrossRefPubMedPubMedCentral Freedman DS, Wang J, Thornton JC, Mei Z, Sopher AB, Pierson RN, Dietz WH, Horlick M: Classification of body fatness by body mass index-for-age categories among children. Arch Pediatr Adolesc Med. 2009, 163 (9): 805-811. 10.1001/archpediatrics.2009.104.CrossRefPubMedPubMedCentral
15.
go back to reference Neovius M, Rasmussen F: Evaluation of BMI-based classification of adolescent overweight and obesity: choice of percentage body fat cutoffs exerts a large influence. The COMPASS study. Eur J Clin Nutr. 2008, 62 (10): 1201-1207. 10.1038/sj.ejcn.1602846.CrossRefPubMed Neovius M, Rasmussen F: Evaluation of BMI-based classification of adolescent overweight and obesity: choice of percentage body fat cutoffs exerts a large influence. The COMPASS study. Eur J Clin Nutr. 2008, 62 (10): 1201-1207. 10.1038/sj.ejcn.1602846.CrossRefPubMed
16.
go back to reference Sollerhed AC, Ejlertsson G: Physical benefits of expanded physical education in primary school: findings from a 3-year intervention study in Sweden. Scand J Med Sci Sports. 2008, 18 (1): 102-107.CrossRefPubMed Sollerhed AC, Ejlertsson G: Physical benefits of expanded physical education in primary school: findings from a 3-year intervention study in Sweden. Scand J Med Sci Sports. 2008, 18 (1): 102-107.CrossRefPubMed
17.
go back to reference Naylor PJ, McKay HA: Prevention in the first place: schools a setting for action on physical inactivity. Br J Sports Med. 2009, 43 (1): 10-13.CrossRefPubMed Naylor PJ, McKay HA: Prevention in the first place: schools a setting for action on physical inactivity. Br J Sports Med. 2009, 43 (1): 10-13.CrossRefPubMed
18.
go back to reference Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, Ogilvie D, Petticrew M, Reeves B, Sutton M, et al: Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J Epidemiol Community Health. 2012, 66 (12): 1182-1186. 10.1136/jech-2011-200375.CrossRefPubMedPubMedCentral Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, Ogilvie D, Petticrew M, Reeves B, Sutton M, et al: Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J Epidemiol Community Health. 2012, 66 (12): 1182-1186. 10.1136/jech-2011-200375.CrossRefPubMedPubMedCentral
19.
go back to reference Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidimann M, Christiansen C, Moeller NC, Leboeuf-Yde C: Study protocol. The childhood health, activity, and motor performance school study Denmark (The CHAMPS-study DK). BMC Pediatr. 2012, 12 (1): 128-10.1186/1471-2431-12-128.CrossRefPubMedPubMedCentral Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidimann M, Christiansen C, Moeller NC, Leboeuf-Yde C: Study protocol. The childhood health, activity, and motor performance school study Denmark (The CHAMPS-study DK). BMC Pediatr. 2012, 12 (1): 128-10.1186/1471-2431-12-128.CrossRefPubMedPubMedCentral
20.
go back to reference Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000, 320 (7244): 1240-1243. 10.1136/bmj.320.7244.1240.CrossRefPubMedPubMedCentral Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000, 320 (7244): 1240-1243. 10.1136/bmj.320.7244.1240.CrossRefPubMedPubMedCentral
21.
go back to reference Williams DP, Going SB, Lohman TG, Harsha DW, Srinivasan SR, Webber LS, Berenson GS: Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Health. 1992, 82 (3): 358-363. 10.2105/AJPH.82.3.358.CrossRefPubMedPubMedCentral Williams DP, Going SB, Lohman TG, Harsha DW, Srinivasan SR, Webber LS, Berenson GS: Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Health. 1992, 82 (3): 358-363. 10.2105/AJPH.82.3.358.CrossRefPubMedPubMedCentral
22.
go back to reference Tanner JM: Growth at Adolescence. 1962, Oxford: Blackwell Scientific Publications, and Springfield: Thomas, 2 Tanner JM: Growth at Adolescence. 1962, Oxford: Blackwell Scientific Publications, and Springfield: Thomas, 2
23.
go back to reference Duke PM, Litt IF, Gross RT: Adolescents' self-assessment of sexual maturation. Pediatrics. 1980, 66 (6): 918-920.PubMed Duke PM, Litt IF, Gross RT: Adolescents' self-assessment of sexual maturation. Pediatrics. 1980, 66 (6): 918-920.PubMed
24.
go back to reference Royston P: Multiple imputation of missing values. Stata J. 2004, 4: 227-241. Royston P: Multiple imputation of missing values. Stata J. 2004, 4: 227-241.
25.
go back to reference Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, Sullivan DK, DuBose K, Mayo MS, Schmelzle KH, Ryan JJ, et al: Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med. 2009, 49 (4): 336-341. 10.1016/j.ypmed.2009.07.022.CrossRefPubMedPubMedCentral Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, Sullivan DK, DuBose K, Mayo MS, Schmelzle KH, Ryan JJ, et al: Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med. 2009, 49 (4): 336-341. 10.1016/j.ypmed.2009.07.022.CrossRefPubMedPubMedCentral
26.
go back to reference Resaland GK, Andersen LB, Mamen A, Anderssen SA: Effects of a 2-year school-based daily physical activity intervention on cardiorespiratory fitness: the Sogndal school-intervention study. Scand J Med Sci Sports. 2011, 21 (2): 302-309. 10.1111/j.1600-0838.2009.01028.x.CrossRefPubMed Resaland GK, Andersen LB, Mamen A, Anderssen SA: Effects of a 2-year school-based daily physical activity intervention on cardiorespiratory fitness: the Sogndal school-intervention study. Scand J Med Sci Sports. 2011, 21 (2): 302-309. 10.1111/j.1600-0838.2009.01028.x.CrossRefPubMed
27.
go back to reference Graf C, Koch B, Falkowski G, Jouck S, Christ H, Staudenmaier K, Tokarski W, Gerber A, Predel HG, Dordel S: School-based prevention: effects on obesity and physical performance after 4 years. J Sports Sci. 2008, 26 (10): 987-994. 10.1080/02640410801930176.CrossRefPubMed Graf C, Koch B, Falkowski G, Jouck S, Christ H, Staudenmaier K, Tokarski W, Gerber A, Predel HG, Dordel S: School-based prevention: effects on obesity and physical performance after 4 years. J Sports Sci. 2008, 26 (10): 987-994. 10.1080/02640410801930176.CrossRefPubMed
28.
go back to reference Khambalia AZ, Dickinson S, Hardy LL, Gill T, Baur LA: A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev. 2012, 13 (3): 214-233. 10.1111/j.1467-789X.2011.00947.x.CrossRefPubMed Khambalia AZ, Dickinson S, Hardy LL, Gill T, Baur LA: A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev. 2012, 13 (3): 214-233. 10.1111/j.1467-789X.2011.00947.x.CrossRefPubMed
29.
go back to reference Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD: Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011, 7 (12): CD001871- Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD: Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011, 7 (12): CD001871-
30.
go back to reference Droyvold WB, Midthjell K, Nilsen TI, Holmen J: Change in body mass index and its impact on blood pressure: a prospective population study. Int J Obes (Lond). 2005, 29 (6): 650-655. 10.1038/sj.ijo.0802944.CrossRef Droyvold WB, Midthjell K, Nilsen TI, Holmen J: Change in body mass index and its impact on blood pressure: a prospective population study. Int J Obes (Lond). 2005, 29 (6): 650-655. 10.1038/sj.ijo.0802944.CrossRef
31.
go back to reference Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H, Brunner-La Rocca HP, van Mechelen W, Puder JJ: Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ. 2010, 340: c785-10.1136/bmj.c785.CrossRefPubMedPubMedCentral Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H, Brunner-La Rocca HP, van Mechelen W, Puder JJ: Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ. 2010, 340: c785-10.1136/bmj.c785.CrossRefPubMedPubMedCentral
32.
go back to reference Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V: School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009, 37 (5): 418-427. 10.1016/j.amepre.2009.07.012.CrossRefPubMed Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V: School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009, 37 (5): 418-427. 10.1016/j.amepre.2009.07.012.CrossRefPubMed
33.
go back to reference Steinberger J, Jacobs DR, Raatz S, Moran A, Hong CP, Sinaiko AR: Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents. Int J Obes (Lond). 2005, 29 (11): 1346-1352. 10.1038/sj.ijo.0803026.CrossRef Steinberger J, Jacobs DR, Raatz S, Moran A, Hong CP, Sinaiko AR: Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents. Int J Obes (Lond). 2005, 29 (11): 1346-1352. 10.1038/sj.ijo.0803026.CrossRef
34.
go back to reference Marcus C, Nyberg G, Nordenfelt A, Karpmyr M, Kowalski J, Ekelund U: A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP. Int J Obes (Lond). 2009, 33 (4): 408-417. 10.1038/ijo.2009.38.CrossRef Marcus C, Nyberg G, Nordenfelt A, Karpmyr M, Kowalski J, Ekelund U: A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP. Int J Obes (Lond). 2009, 33 (4): 408-417. 10.1038/ijo.2009.38.CrossRef
35.
go back to reference Connelly JB, Duaso MJ, Butler G: A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public health. 2007, 121 (7): 510-517. 10.1016/j.puhe.2006.11.015.CrossRefPubMed Connelly JB, Duaso MJ, Butler G: A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public health. 2007, 121 (7): 510-517. 10.1016/j.puhe.2006.11.015.CrossRefPubMed
36.
go back to reference Khambalia AZ, Dickinson S, Hardy LL, Gill T, Baur LA: A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev. 2011, 13 (3): 214-233.CrossRefPubMed Khambalia AZ, Dickinson S, Hardy LL, Gill T, Baur LA: A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev. 2011, 13 (3): 214-233.CrossRefPubMed
37.
go back to reference Doak C, Heitmann BL, Summerbell C, Lissner L: Prevention of childhood obesity - what type of evidence should we consider relevant?. Obes Rev. 2009, 10 (3): 350-356. 10.1111/j.1467-789X.2008.00550.x.CrossRefPubMed Doak C, Heitmann BL, Summerbell C, Lissner L: Prevention of childhood obesity - what type of evidence should we consider relevant?. Obes Rev. 2009, 10 (3): 350-356. 10.1111/j.1467-789X.2008.00550.x.CrossRefPubMed
Metadata
Title
Effect of four additional physical education lessons on body composition in children aged 8–13 years – a prospective study during two school years
Authors
Heidi Klakk
Mai Chinapaw
Malene Heidemann
Lars Bo Andersen
Niels Wedderkopp
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2013
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/1471-2431-13-170

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