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789. Effects of a ‘school-based’ physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the ‘Physical Activity 4 Everyone’ RCT

Research Article
J L Hollis, R Sutherland, L Campbell, P J Morgan, D R Lubans, N Nathan, L Wolfenden, A D Okely, L Davies, A Williams, K E Cohen, C Oldmeadow, K Gillham and J Wiggers
August 2016

Commentary by Rona Macniven, GlobalPANet Executive, The University of Sydney Australia

Physical activity plays a crucial role in energy balance and preventing obesity in young people at a time where overweight/obesity rates are a societal issue. However, not all physical activity programs can demonstrate weight loss. Inequalities also exist in many countries where children from socially disadvantaged backgrounds are more likely to be overweight/obese. This paper found favourable weight changes as a result of an intervention in 10 high schools in disadvantaged communities in New South Wales, Australia. 

The ‘Physical Activity 4 Everyone’ (PA4E1) study was a comprehensive intervention involving seven components across the curriculum, school environment and parents and the community delivered over seven to eight school terms (up to two years). These were: strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme; physical activity during school breaks, modification of school policy; and parent engagement, links with community physical activity providers. Half of the 10 schools received the program during this time and the other half undertook their usual curriculum as the control group. Over 1000 students from all schools had their weight (kg), body mass index (BMI) and BMIz-score collected at baseline in Grade 7 and 12 and 24 months later. Their physical activity levels at baseline were also measured using accelerometers. 

At 12 months, significant weight and BMI reductions were found for the intervention group compared to the control group (weight mean difference=–0.90 kg (95% confidence interval (CI)=–1.50, −0.30, P<0.01) and BMI (−0.28 kg m−2 (−0.50, −0.06), P=0.01). Findings were not significant for BMI z-score at 12 months but modest yet significant overall reductions across all three outcomes were evident after two years. For weight, these were less than 1kg (−0.62 kg (−1.21, 0.03), P=0.01); BMI reduced by 0.28 kg m−2 (−0.49, −0.06), P=0.01; and BMI z-score −0.08 (−0.14; −0.02), P=0.02). 

Health outcomes in disadvantaged communities are hard to achieve therefore the effectiveness of this intervention can be commended. It is a positive outcome for physical activity interventions in a more general sense too as weight improvements can be hard to elucidate when other energy balance behaviours can have a strong effect. Testing the replication of this program in other settings and experimenting with different types of delivery would be a future avenue for research in this area. Yet the effectiveness of this program already shows a clear direction of focus for other programs aiming to reduce overweight and obesity rates in young people. 

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