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Cited by 1,358Physical Activity and HealthObesity, Physical Activity, DietSchool Health and Nursing Education

The DOI matches its Crossref record; 1,063 of the 1,138 references it cites were found in a registry or an index; none of the 164 sources its claims cite is checked for support yet.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

Open access
Dobbins, Maureen, Husson, Heather, DeCorby, Kara, LaRocca, Rebecca L·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007651.pub2PMC PMC8459921
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Abstract

BACKGROUND: Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES: The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA: Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS: Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity in

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TL;DR

This updated Cochrane review of 44 RCTs (36,593 participants) found school-based physical activity interventions had mixed, generally modest effects on children’s physical activity and fitness. The evidence was graded low quality and likely overestimates true treatment effects.

Key findings

  • Behavioral outcomes were mixed: 2 of 5 studies reported significant positive effects on physical activity rates, 14 of 23 on duration of MVPA, and 7 of 16 on television viewing (with 1 favoring control). Simon 2004 found intervention children were almost three times more likely to be active outside school (OR 2.74, 95% CI 2.01 to 3.75); Robinson 1999 reported a 50-minute/day decrease in TV viewing versus 10 minutes/day in controls (P < 0.001).
  • Physical health outcomes showed limited positive effects: 4 of 16 studies for systolic blood pressure, 3 of 16 for diastolic blood pressure, 1 of 10 for cholesterol, 8 of 32 for BMI, 4 of 6 for VO₂max, and 1 of 6 for pulse rate. BMI intervention groups gained 0.1 to 1.0 kg/m² less than controls; VO₂max improvements ranged from 1.6 to 3.7 mL/kg/min.
  • The review’s GRADE ratings for main outcomes were low quality. Longer interventions and combinations of school curricula, printed educational materials, educational sessions, physical activity sessions, and community-based strategies were suggested as potentially effective, but effects were modest.

Methods

  • Systematic review of randomized controlled trials; inclusion required a school-based intervention relevant to public health practice, aimed at all school-attending children aged 6 to 18, with a minimum duration of 12 weeks. Searches ran to October 2011 and identified 44 included studies with 36,593 participants.
  • Two independent reviewers assessed relevance, extracted data, and evaluated risk of bias using Cochrane criteria. Results were synthesized narratively because populations, interventions, and outcomes varied widely; no meta-analysis was conducted.

Limitations

  • The paper states major limitations: lack of blinding (especially outcome assessors), reliance on self-report for most behavioral outcomes, inconsistent outcome measurement, poor description of randomization, unit-of-analysis errors, few intention-to-treat analyses (16 studies), and high attrition/incomplete data—all likely overestimating treatment effects.
  • The paper also states that adverse effects were generally not reported, cost-effectiveness was assessed in only one study, searches were limited to English-language databases, and applicability to low- and middle-income countries is unclear.
  • Evident from the text: most studies were conducted in developed countries, populations and interventions were highly heterogeneous, and no meta-analysis was possible, limiting generalizability and precision.

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Crossref · 10.1002/14651858.cd007651.pub2

Cites

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  • It may state two separate claims as one. 159
  • Probably not a substantial claim. 296
  • The quote only partly states this claim. 5
392 of 392

  • The paper relies on this without support.

    It is uncertain which strategies best promote lifelong healthy behavior.

    “However, it is not clear what the most effective strategies are to promote life-long healthy behaviors.”

  • The paper relies on this without support.

    Similar criteria have been adopted in recent Cochrane reviews.

    “Similar criteria have been implemented in recent Cochrane reviews.”

  • The paper relies on this without support.

    In several developed countries, more than half of school-attending children are overweight.

    “This decision was made because in a number of developed countries more than half of school attending children are overweight.”
3 of 3

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Television-viewing effect count changes from seven to six

    Minor

    The same discussion first identifies seven studies with statistically significant positive effects, then refers to six such studies.

  • VO2-max measurement methods are counted differently

    Minor

    One passage divides the six studies equally between blood-gas measurement and pulse-rate proxies; the later breakdown names two blood-gas studies and four proxy studies.

  • Television-viewing measurement is described as both entirely and not entirely self-reported

    Minor

    The results section says all studies measured television viewing by self-report, but the quality discussion says one study did not rely on self-report.

  • Luepker pulse-rate effect is placed at conflicting follow-up times

    Minor

    The narrative says the significant effect appeared three years after the intervention, whereas Appendix 13 reports P = 0.03 at the end of the three-year intervention.

  • Li 2010 total does not match group counts

    Minor

    The reported intervention and control counts sum to 4,120, not the stated total of 4,210.

    Reported 4210 · recomputed 4120

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Metadata

Authors
Dobbins, M., Husson, H., DeCorby, K., & LaRocca, R. L.
Affiliations
McMaster University (CA)
ORCID
Dobbins, Maureen
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-02-28
Volume
9
Issue
2
Pages
CD007651-CD007651
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd007651.pub2
PMC
PMC8459921
OpenAlex
W2135517195
Semantic Scholar
face32f1e749dbd58a539175a8c46efc30d85a9a
Cited by
1,358
References
1,138
Citations by year
2026: 31 · 2025: 67 · 2024: 91 · 2023: 86 · 2022: 110 · 2021: 103 · 2020: 93 · 2019: 87 · 2018: 97 · 2017: 87 · 2016: 105 · 2015: 116 · 2014: 87 · 2013: 64
FWCI
13.41
Type
journal article
Language
en
Update notices
new_version (2021-09-23)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
Keywords
school-based physical activity intervention, children and adolescents, moderate-to-vigorous physical activity, physical fitness, body composition, body mass index, sedentary time, health-related quality of life, intervention effectiveness, cardiometabolic health, adiposity, intervention components, physical activity guidelines, adverse events, school health promotion, physical education, recess, recess games
MeSH terms
Adolescent, Child, Health Promotion, Humans, Motor Activity, Physical Fitness, Schools, Program Evaluation, Exercise, Randomized Controlled Trials as Topic

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