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Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial
Open accessAbstract
OBJECTIVE: To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren. DESIGN: Cluster randomised controlled trial. SETTING: 28 classes from 15 elementary schools in Switzerland randomly selected and assigned in a 4:3 ratio to an intervention (n=16) or control arm (n=12) after stratification for grade (first and fifth grade), from August 2005 to June 2006. PARTICIPANTS: 540 children, of whom 502 consented and presented at baseline. INTERVENTION: Children in the intervention arm (n=297) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week, daily short activity breaks, and physical activity homework. Children (n=205) and parents in the control group were not informed of an intervention group. For most outcome measures, the assessors were blinded. MAIN OUTCOME MEASURES: Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). Secondary outcome measures included body mass index and cardiovascular risk score (average z score of waist circumference, mean blood pressure, blood glucose, inverted high density lipoprotein cholesterol, and triglycerides). RESULTS: 498 children completed the baseline and follow-up assessments (mean age 6.9 (SD 0.3) years for first grade, 11.1 (0.5) years for fifth grade). After adjustment for grade, sex, baseline values, and clustering within classes, children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds (-0.12, 95 % confidence interval -0.21 to -0.03; P=0.009). Likewise, their z scores for aerobic fitness increased more favourably (0.17, 0.01 to 0.32; P=0.04), as did those for moderate-vigorous physical activity in school (1.19, 0.78 to 1.60; P<0.001), all day moderate-vigorous physical activity (0.44, 0.05 to 0.82; P=0.03), and total physical activity in school (0.92, 0.35 to 1.50; P=0.003). Z scores for overall daily physical activity (0.21, -0.21 to 0.63) and physical quality of life (0.42, -1.23 to 2.06) as well as psychological quality of life (0.59, -0.85 to 2.03) did not change significantly. CONCLUSIONS: A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children. Trial registration Current Controlled Trials ISRCTN15360785.
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“A number of studies combined aspects of the TEO in a multicomponent approach.64, 91, 99”
From A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children (2020) · cites this paper as [64]
In the citing paper
“Low risk Comment: intention-to-treat principle employed”
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 Kriemler 2010
In the citing paper
“Low risk Comment: relevant confounders taken into account”
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 Kriemler 2010
In the citing paper
“Low risk Comment: randomized using a random numbers table”
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 Kriemler 2010
In the citing paper
“Low risk Comment: criterion not applicable because all participants were allocated at 1 point in time following recruitment, so at time of recruitment allocation was not known”
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 Kriemler 2010
In the citing paper
“High risk Quote:”
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 Kriemler 2010
In the citing paper
“Low risk Comment: 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 Kriemler 2010
In the citing paper
“Low risk Comment: data collection tools reported to be valid and reliable”
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 Kriemler 2010
In the citing paper
“Kriemler 2010 End of intervention 502 boys and girls 101 102 P = 0.88 0 (95% CI -0.3 to 0.2)”
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 Kriemler 2010
In the citing paper
“Another more recent 1-year multicomponent school-based physical activity intervention found improvements in accelerometer-assessed moderate to vigorous physical activity as well as in body composition.257”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [257]
In the citing paper
“In controlled trials, such multicomponent interventions often increase the amount and/or intensity of physical activity during school hours.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [257]
In the citing paper
“More recent multicomponent school-based PE/physical activity interventions in Europe demonstrated improvements over 1 academic year in aerobic fitness, skin-fold thickness, and/or BMI z score overall or in certain subgroups.257,261”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [257]
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MethodExercise and Childhood Obesity
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Self-citationStrategies for physical activity intervention in youth
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“Our findings were echoed by the results of the KISS study [21], in which the intervention was beneficial on facilitating in-school MVPA [1.”
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Bone, fat and muscle gain in pubertal girls : effects of physical activity
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“In Switzerland, the KISS study is an example of a school-based intervention that effectively increased physical activity levels in children [7].”
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“The results of this study indicate that an intervention aimed at increasing PA level in children is associated with a favorable effect on body composition, aerobic fitness and cardiovascular risk profile (Kriemler et al., 2010).”
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Adölesanların Kilo Yönetiminde 5210 Beslenme Yönetimi Programının Etkisi
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Einfluss von Bewegung und Sport auf die Gesundheit und Entwicklung
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Self-citationLilić, A., Petković, E., Karišik, S., Bjelojević, L., Gardašević, N., & Joksimović, M. (2021) · Baltic Journal of Sport and Health Sciences · doi:10.33607/bjshs.v2i121.1083 · Cited by 1
“Also, additional physical activity that was applied twice a week for one year, in addition to standard school hours, showed effects on anthropometric values and physical abilities (Kriemler et al., 2010).”
BackgroundMethodInfluential Research Articles Involving Physical Education: A Bibliometric Analysis
Wyant, J., Keath, A., Tsuda, E., & Baek, J.-H. (2021) · Journal of Physical Education and Sports Management · doi:10.15640/jpesm.v8n1a1
‘Children at Risk’ in Public Health Policy
Borgen, J. S., Rugseth, G., & Bjorbækmo, W. S. (2020) · BRILL eBooks · doi:10.1163/9789004445666_009
“Within the field of health research, there is a substantial body of intervention studies and randomised controlled trials that seek evidence of the benefits of physical activity for children and youth (Adab et al., 2018; Kriemler et al., 2010; Skrede, 2019).”
BackgroundRibault, L. (1990) · PubMed
(2010) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2010.61
Donnelly, S., Buchan, D. S., McLellan, G., & Arthur, R. (2020) · SportRxiv (OSF Preprints) · doi:10.31236/osf.io/a2znt
Norhisham, Z., Yusop, N. B. M., Ibrahim, Z., & Shariff, Z. M. (2022) · doi:10.2196/preprints.38924
Motorické dovednosti v kontextu kognitivních procesů a self-conceptu dítěte
Miklánková, L., Pugnerová, M., & Rechtik, Z. (2021) · doi:10.5507/pdf.21.24460352
Physical activity, exercise, and the metabolic syndrome
Haapala, E. A., & Leppänen, M. H. (2023) · doi:10.1093/med/9780192843968.003.0020
Kelly, L. A. (2024) · Journal of Pediatric Advance Research · doi:10.46889/jpar.2024.3104
Catastrophic health effects of obesity in children and what we can do
Kriemler, S., Stadtfeld, T., Schaub, F., Siaplourus, J., & Koenig, T. (2025) · Sports Orthopaedics and Traumatology · doi:10.1016/j.orthtr.2025.05.002
Self-citationOlgacher, D., Wallace, C., Brennan, S., Lavelle, F., Moore, S. E., McKinley, M. C., McCole, P., Hunter, R. F., Dunne, L., Cardwell, C. R., et al. (2025) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-025-01842-4
“Based on a standard deviation (SD) of 4.5 for the SDQ [24] and an intracluster correlation coefficient (ICC) of 0.10 informed by prior analyses [25, 26], the study had > 80% power at the 5% significance level to detect a 2.8-point difference in SDQ scores.”
InfluentialTassitano, R. M., Weaver, R. G., Tenório, M. C. M., Brazendale, K., & Beets, M. W. (2020) · Figshare · doi:10.6084/m9.figshare.13336081
Brandes, B., Sell, L., Buck, C., Busse, H., Zeeb, H., & Brandes, M. (2024) · Figshare · doi:10.6084/m9.figshare.26611439
Brandes, B., Sell, L., Buck, C., Busse, H., Zeeb, H., & Brandes, M. (2024) · Figshare · doi:10.6084/m9.figshare.26611451
Brennan, S., Lavelle, F., Moore, S. E., Dean, M., McKinley, M. C., McCole, P., Hunter, R. F., Dunne, L., O’Connell, N. E., Cardwell, C. R., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13719606
Long, K. Z., Beckmann, J., Lang, C., Seelig, H., Nqweniso, S., Probst-Hensch, N., Müller, I., Pühse, U., Steinmann, P., du Randt, R., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19076349
Metadata
- Authors
- Kriemler, S., Zahner, L., Schindler, C., Meyer, U., Hartmann, T., Hebestreit, H., Brunner-La Rocca, H. P., van Mechelen, W., & Puder, J. J.
- Affiliations
- Swiss Tropical and Public Health Institute (CH)
- University of Basel (CH)
- Universitätsklinikum Würzburg (DE)
- University of Lausanne (CH)
- Corresponding author
- Kriemler, S.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2010-02-23
- Volume
- 340
- Issue
- feb23 1
- Pages
- c785-c785
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2827713
- OpenAlex
- W1990388280
- Cited by
- 524
- References
- 50
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 16 · 2023: 19 · 2022: 24 · 2021: 46 · 2020: 31 · 2019: 31 · 2018: 35 · 2017: 30 · 2016: 56 · 2015: 36 · 2014: 38 · 2013: 45 · 2012: 43
- FWCI
- 29.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- IRIS (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Science Foundation
- Universität Basel
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (114401)
- Economic and Social Research Council (ES/G007462/1)
- 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
- Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
- Keywords
- elementary school students, physical education, adiposity, fat mass, cardiorespiratory fitness, moderate-to-vigorous physical activity, quality of life, cardiovascular risk, blood pressure, blood glucose, HDL cholesterol, triglycerides, active breaks, childhood obesity prevention, Switzerland, Lausanne
- MeSH terms
- Child, Exercise Therapy, Health Status, Humans, Mental Health, Obesity, Physical Fitness, School Health Services, Cluster Analysis, Treatment Outcome, Adiposity
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