Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children
Abstract
Objective Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors.Methods We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77).Results INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables.Conclusion Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis.
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In Reed 2008, the method of random sequence generation was unclear: the person who remotely randomized schools was not involved in the trial, but how randomization was performed was not described.
“schools were then remotely randomized to either Usual Practice or Intervention by an epidemiologist not involved in the trial”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
In Reed 2008, blinding was of unclear risk because no information was provided and it was likely not done.
“no information given, likely not done”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
In Reed 2008, the validity and reliability of the physical activity measure were not discussed.
“reliability and validity of the physical activity measure was not discussed”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
In Reed 2008, confounding was adequately controlled.
“all relevant confounders controlled for”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
In Reed 2008, selective reporting bias was low because all a priori identified outcomes were reported.
“all outcomes identified a priori were reported on”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
In Reed 2008, allocation concealment was not achieved because schools could not be blinded to random assignment.
“it was reported that it was not possible for schools to be blinded to random assignment and therefore concealment not attained”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
In Reed 2008, attrition bias was high because incomplete outcome data were not adequately addressed.
“incomplete outcome data not adequately addressed”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Reed 2008
Cites
Prediction of coronary heart disease using risk factor categories
Wilson, P. W. F., D’Agostino, R. B., Levy, D., Belanger, A. M., Silbershatz, H., & Kannel, W. B. (1998) · Circulation · doi:10.1161/01.cir.97.18.1837 · Cited by 9,581 · see citing works
Health benefits of physical activity: the evidence
Warburton, D. E. R. (2006) · Canadian Medical Association Journal · doi:10.1503/cmaj.051351 · Cited by 8,007 · see citing works
Self-citationNational High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) · PEDIATRICS · doi:10.1542/peds.114.2.s2.555 · Cited by 6,895 · see citing works
Tanner, J. M. (1978) · Medical Entomology and Zoology · Cited by 3,742 · see citing works
The multistage 20 metre shuttle run test for aerobic fitness
Léger, L., Mercier, D., Gadoury, C., & Lambert, J. (1988) · Journal of Sports Sciences · doi:10.1080/02640418808729800 · Cited by 2,539 · see citing works
Freedman, D. S., Dietz, W. H., Srinivasan, S. R., & Berenson, G. S. (1999) · Pediatrics · doi:10.1542/peds.103.6.1175 · Cited by 2,456 · see citing works
Health consequences of obesity
Reilly, J. J. (2003) · Archives of Disease in Childhood · doi:10.1136/adc.88.9.748 · Cited by 1,652 · see citing works
van Sluijs, E. M. F., McMinn, A. M., & Griffin, S. J. (2007) · BMJ · doi:10.1136/bmj.39320.843947.be · Cited by 1,120 · see citing works
Luepker, R. V. (1996) · JAMA · doi:10.1001/jama.1996.03530340032026 · Cited by 1,023 · see citing works
Crocker, P. R. E., Bailey, D. A., Faulkner, R. A., Kowalski, K. C., & McGRATH, R. (1997) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199710000-00011 · Cited by 974 · see citing works
Sallis, J. F., McKenzie, T. L., Alcaraz, J. E., Kolody, B., Faucette, N., & Hovell, M. F. (1997) · American Journal of Public Health · doi:10.2105/ajph.87.8.1328 · Cited by 914 · see citing works
Bao, W., Threefoot, S. A., Srinivasan, S., & Berenson, G. (1995) · American Journal of Hypertension · doi:10.1016/0895-7061(95)00116-7 · Cited by 798 · see citing works
Adolescent Self-assessment of Sexual Maturation
Neinstein, L. S. (1982) · Clinical Pediatrics · doi:10.1177/000992288202100806 · Cited by 783 · see citing works
Adolescents' Self-Assessment of Sexual Maturation
Duke, P. M., Litt, I. F., & Gross, R. T. (1980) · PEDIATRICS · doi:10.1542/peds.66.6.918 · Cited by 685 · see citing works
Secular trends in the body mass index of Canadian children.
Tremblay, M. S., & Willms, J. D. (2000) · Europe PMC (PubMed Central) · Cited by 456 · see citing works
Effects of Diet and Exercise on Obesity-Related Vascular Dysfunction in Children
Woo, K. S., Chook, P., Yu, C. C.-W., Sung, R. Y. T., Qiao, M., Leung, S. S. F., Lam, C. W. K., Metreweli, C., & Celermajer, D. S. (2004) · Circulation · doi:10.1161/01.cir.0000126599.47470.be · Cited by 455 · see citing works
Temporal trends in overweight and obesity in Canada, 1981–1996
Tremblay, M., Katzmarzyk, P. T., & Willms, J. (2002) · International Journal of Obesity · doi:10.1038/sj.ijo.0801923 · Cited by 445 · see citing works
Evidence for secular trends in children's physical activity behaviour
Dollman, J., Norton, K., & Norton, L. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.016675 · Cited by 427 · see citing works
The Comprehensive School Health Program: Exploring an Expanded Concept
Allensworth, D. D., & Kolbe, L. J. (1987) · Journal of School Health · doi:10.1111/j.1746-1561.1987.tb03183.x · Cited by 399 · see citing works
Pratt, M., Macera, C. A., & Blanton, C. (1999) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199911001-00007 · Cited by 368 · see citing works
School-Based Physical Activity Does Not Compromise Children's Academic Performance
AHAMED, Y., MACDONALD, H., REED, K., NAYLOR, P.-J., LIU-AMBROSE, T., & MCKAY, H. (2007) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000241654.45500.8e · Cited by 314 · see citing works
Self-citationComprehensive approaches to school health promotion: how to achieve broader implementation?
Deschesnes, M. (2003) · Health Promotion International · doi:10.1093/heapro/dag410 · Cited by 298 · see citing works
Andersen, L. B., Wedderkopp, N., Hansen, H., Cooper, A. R., & Froberg, K. (2003) · Preventive Medicine · doi:10.1016/s0091-7435(03)00145-2 · Cited by 241 · see citing works
Advanced Statistics:Statistical Methods for Analyzing Cluster and Cluster-randomized Data
Wears, R. L. (2002) · Academic Emergency Medicine · doi:10.1197/aemj.9.4.330 · Cited by 206 · see citing works
Harrell, J. S., McMurray, R. G., Bangdiwala, S. I., Frauman, A. C., Gansky, S. A., & Bradley, C. B. (1996) · The Journal of Pediatrics · doi:10.1016/s0022-3476(96)70332-3 · Cited by 189 · see citing works
Riley, W. A., Freedman, D. S., Higgs, N., et al. (1986) · Arteriosclerosis An Official Journal of the American Heart Association Inc · doi:10.1161/01.atv.6.4.378 · Cited by 183 · see citing works
Nicklas, T. A., von DUVILLARD, S. P., & Berenson, G. S. (2002) · International Journal of Sports Medicine · doi:10.1055/s-2002-28460 · Cited by 181 · see citing works
Vandongen, R., Jenner, D. A., Thompson, C., Taggart, A. C., Spickett, E. E., Burke, V., Beilin, L. J., Milligan, R., & Dunbar, D. (1995) · Preventive Medicine · doi:10.1006/pmed.1995.1003 · Cited by 179 · see citing works
Naylor, P., MACDONALD, H. M., Zebedee, J. A., Reed, K. E., & McKay, H. A. (2006) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2006.06.013 · Cited by 173 · see citing works
Self-citationChen, W., Srinivasan, S. R., Li, S., Xu, J., & Berenson, G. S. (2005) · Diabetes Care · doi:10.2337/diacare.28.1.126 · Cited by 167 · see citing works
Powers, S. K., Lennon, S. L., Quindry, J. C., & Mehta, J. L. (2002) · Current Opinion in Cardiology · doi:10.1097/00001573-200209000-00009 · Cited by 151 · see citing works
Harjai, K. J. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-131-5-199909070-00009 · Cited by 150 · see citing works
Twisk, J. W. R., Kemper, H. C. G., & van Mechelen, W. (2002) · International Journal of Sports Medicine · doi:10.1055/s-2002-28461 · Cited by 122 · see citing works
Health benefits of physical activity
Warburton, D. E. R. (2006) · Canadian Medical Association Journal · doi:10.1503/cmaj.1060147 · Cited by 113 · see citing works
Self-citationVerstraete, S. J., Cardon, G. M., De Clercq, D. L., & De Bourdeaudhuij, I. M. (2007) · Public Health Nutrition · doi:10.1017/s1368980007223900 · Cited by 104 · see citing works
Tracy, R. E. (1995) · Atherosclerosis · doi:10.1016/0021-9150(95)05525-2 · Cited by 102 · see citing works
Physical activity and biological risk factors clustering in pediatric population
Ribeiro, J. C., Guerra, S., de Oliveira, J. J. F., Teixeira-Pinto, A., Twisk, J. W. R., Duarte, J. A., & Mota, J. A. P. S. (2004) · Preventive Medicine · doi:10.1016/j.ypmed.2004.02.023 · Cited by 77 · see citing works
Established and Recently Identified Coronary Heart Disease Risk Factors in Young People
Thomas, N. E., Baker, J. S., & Davies, B. (2003) · Sports Medicine · doi:10.2165/00007256-200333090-00001 · Cited by 67 · see citing works
Ethnicity and tracking blood pressure in children
Lane, D. A., & Gill, P. S. (2004) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001674 · Cited by 49 · see citing works
Structured Opportunities for Student Physical Activity in Ontario Elementary and Secondary Schools
Allison, K. R., & Adlaf, E. M. (2000) · Canadian Journal of Public Health · doi:10.1007/bf03404810 · Cited by 36 · see citing works
Measurement of left ventricular wall mass in pediatric populations.
Schieken, R. M. (1987) · Hypertension · doi:10.1161/01.hyp.9.2_pt_2.ii47 · Cited by 15 · see citing works
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Cited by
Sorted by citations
Interventions for preventing obesity in children
Waters, E., de Silva-Sanigorski, A., Burford, B. J., Brown, T., Campbell, K. J., Gao, Y., Armstrong, R., Prosser, L., & Summerbell, C. D. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001871.pub3 · Cited by 1,455 · see citing works
Dobbins, M., Husson, H., DeCorby, K., & LaRocca, R. L. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007651.pub2 · Cited by 1,358 · see citing works
Kriemler, S., Meyer, U., Martin, E., van Sluijs, E. M. F., Andersen, L. B., & Martin, B. W. (2011) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090186 · Cited by 827 · see citing works
Langford, R., Bonell, C. P., Jones, H. E., Pouliou, T., Murphy, S. M., Waters, E., Komro, K. A., Gibbs, L. F., Magnus, D., & Campbell, R. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008958.pub2 · Cited by 768 · see citing works
The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion
Beets, M. W., Okely, A., Weaver, R. G., Webster, C., Lubans, D., Brusseau, T., Carson, R., & Cliff, D. P. (2016) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-016-0442-2 · Cited by 205 · see citing works
Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009728.pub3 · Cited by 178 · see citing works
Physical Activity and Skills Intervention: SCORES Cluster Randomized Controlled Trial
COHEN, K. E., MORGAN, P. J., PLOTNIKOFF, R. C., CALLISTER, R., & LUBANS, D. R. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000452 · Cited by 150 · see citing works
Martin, A., Saunders, D. H., Shenkin, S. D., & Sproule, J. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009728.pub2 · Cited by 149 · see citing works
Systematic review on evidence‐based adolescent nutrition interventions
Lassi, Z. S., Moin, A., Das, J. K., Salam, R. A., & Bhutta, Z. A. (2017) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13335 · Cited by 117 · see citing works
Oosterhoff, M., Joore, M., & Ferreira, I. (2016) · Obesity Reviews · doi:10.1111/obr.12446 · Cited by 87 · see citing works
Lubans, D. R., Morgan, P. J., Weaver, K., Callister, R., Dewar, D. L., Costigan, S. A., Finn, T. L., Smith, J., Upton, L., & Plotnikoff, R. C. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-427 · Cited by 48 · see citing works
Habib-Mourad, C., Ghandour, L. A., Maliha, C., Awada, N., Dagher, M., & Hwalla, N. (2020) · BMC Public Health · doi:10.1186/s12889-020-8351-3 · Cited by 28 · see citing works
Knox, G. J., Baker, J. S., Davies, B., Rees, A., Morgan, K., Cooper, S.-M., Brophy, S., & Thomas, N. E. (2012) · American Journal of Health Promotion · doi:10.4278/ajhp.110617-quan-258 · Cited by 20 · see citing works
- Authors
- Reed, K. E., Warburton, D. E. R., Macdonald, H. M., Naylor, P. J., & McKay, H. A.
- Affiliations
- University of British Columbia (CA)
- Vancouver Coastal Health (CA)
- University of Victoria (CA)
- Corresponding author
- McKay, Heather A.
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 46
- Issue
- 6
- Pages
- 525-531
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2009554524
- Cited by
- 124
- References
- 42
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 4 · 2018: 9 · 2017: 10 · 2016: 7 · 2015: 11 · 2014: 12 · 2013: 9 · 2012: 16
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- school-based physical activity intervention, cardiovascular risk factors, elementary school students, cardiorespiratory fitness, blood pressure, body mass index, lipid profile, C-reactive protein, fibrinogen, apolipoprotein B
- MeSH terms
- Blood Pressure, British Columbia, Cardiovascular Diseases, Child, Child Welfare, Female, Humans, Male, Motor Activity, Physical Fitness, Risk Factors, School Health Services, Schools, Program Evaluation, Body Mass Index, Program Development
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