A Multifactorial Weight Reduction Programme for Children with Overweight and Asthma:A Randomized Controlled Trial

BACKGROUND:There is increasing evidence that obesity is related to asthma development and severity. However, it is largely unknown whether weight reduction can influence asthma management, especially in children. OBJECTIVE:To determine the effects of a multifactorial weight reduction intervention on asthma management in overweight/obese children with (a high risk of developing) asthma. METHODS:An 18-month weight-reduction randomized controlled trial was conducted in 87 children with overweight/obesity and asthma. Every six months, measurements of anthropometry, lung function, lifestyle parameters and inflammatory markers were assessed. Analyses were performed with linear mixed models for longitudinal analyses. RESULTS:After 18 months, the body mass index-standard deviation score decreased by -0.14±0.29 points (p0.05). Asthma features (including asthma control and asthma-related quality of life) and lung function indices (static and dynamic) improved significantly over time in both groups. The FVC% predicted improved over time by 10.1 ± 8.7% in the intervention group (p<0.001), which was significantly greater than the 6.1 ± 8.4% in the control group (p<0.05). CONCLUSIONS & CLINICAL RELEVANCE:Clinically relevant improvements in body weight, lung function and asthma features were found in both the intervention and control group, although some effects were more pronounced in the intervention group (FVC, asthma control, and quality of life). This implies that a weight reduction intervention could be clinically beneficial for children with asthma. TRIAL REGISTRATION:ClinicalTrials.gov NCT00998413

Challenges in evaluating implementation and effectiveness in real-world settings: evaluation proposal for school-based health-promoting intervention

There are various research designs and approaches to investigate how health-promoting activities are implemented in complex, real-world systems, and to identify potential health effects that might occur following implementation. Although literature describes guidelines to perform and report about implementation research and effect evaluations, no specific guidelines exist on analysing and reporting about the combination of effectiveness data and implementation data collected as part of intervention evaluation in complex and diverse settings. This paper describes the evaluation of primary school-based health-promoting activities in complex systems. Furthermore, an approach for data categorisation inspired by Rogers’ Diffusion of Innovations theory is presented that can facilitate structuring the study’s results and relating the degree of implementation to any impact on effectiveness outcomes that might be observed. Researchers interested in using this approach for data categorisation have to ensure that the following three conditions are met: (i) data on an intervention’s efficacy in a controlled setting with optimal implementation is available; (ii) key points that define an intervention’s optimal implementation are available and (iii) an evaluation study is performed, collecting both effectiveness data and implementation data in a real-world context. This data categorisation approach can be useful to generate more insight into an intervention’s effectiveness under varying circumstances, and optimal support and advice can be provided to stakeholders to achieve maximum impact of population-based health-promoting interventions in complex, real-world systems. However, the proposed approach is a first suggestion and further testing and adaptation is necessary to increase its usefulness. Knowledge and experience sharing among researchers performing comparable research can increase the knowledge base regarding this subject

Leefstijlinterventie voor kinderen met obesitas:Hoe jonger, hoe beter

Doel Het doel van deze studie was om de prevalentie van gewichtsgerelateerde comorbiditeit bij schoolkinderen met obesitas in kaart te brengen en deze prevalentie en het effect van gecombineerde leefstijlinterventie gedurende een jaar te vergelijken tussen kinderen van basisschool- en middelbare-schoolleeftijd en tussen jongens en meisjes. Opzet Cross-sectionele analyse en quasi-experimentele gecombineerde leefstijlinterventie. Methode Het gewichtsgerelateerde gezondheidsrisico en comorbiditeit werden onderzocht bij 149 kinderen van de basisschoolleeftijd en 150 kinderen van middelbare-schoolleeftijd met obesitas. Het effect van een gecombineerde leefstijlinterventie, die werd aangeboden vanuit een domein-overstijgend netwerk, werd onderzocht bij 82 kinderen van de basisschoolleeftijd en 75 kinderen van middelbare-schoolleeftijd. Resultaten Bij kinderen van de basisschoolleeftijd zagen we al vaak insulineresistentie (37%), gestoorde glucosetolerantie (3%), dyslipidemie (48%), hypertensie (7%) en verhoogde leverenzymwaarden (54%). Alleen glomerulaire hyperfiltratie en insulineresistentie kwamen vaker voor bij kinderen van middelbare-schoolleeftijd. Gestoorde glucosetolerantie kwam vaker voor bij meisjes dan bij jongens. De afname in de BMI-z-score na interventie was groter bij kinderen van de basisschoolleeftijd dan bij kinderen van middelbare-schoolleeftijd, net als de daling in LDL-cholesterolconcentratie en de verbetering van de z-score voor systolische bloeddruk. Bij jongens daalde de BMI-z-score sterker dan bij meisjes, maar de verbetering van de overige gezondheidsparameters verschilde niet. Conclusie Bij kinderen met obesitas komt comorbiditeit al op de basisschoolleeftijd frequent voor. Het effect van de gecombineerde leefstijlinterventie op comorbiditeit was groter bij kinderen van de basisschoolleeftijd dan bij kinderen van middelbare-schoolleeftijd. Deze resultaten benadrukken het belang van vroege preventie en interventies die het ontstaan van obesitas en gezondheidsgevolgen beogen te voorkomen

Feasibility and Effect of the Exergame BOOSTH Introduced to Improve Physical Activity and Health in Children: Protocol for a Randomized Controlled Trial

BACKGROUND: Despite the well-known beneficial health effects of physical activity (PA), the majority of Dutch primary school children do not meet the recommended PA guidelines. Although there is growing evidence on the effectiveness of exergames for PA in children, there is limited evidence on their effect on health outcomes, such as cardiovascular health and health-related quality of life (HRQOL), and on factors influencing their effectiveness and feasibility. The exergame BOOSTH uses a wrist-worn activity tracker to measure steps per day. As a reward for the performed PA, children can unlock levels in the online BOOSTH game. In addition, "BOOSTH battle" enables competition between groups. OBJECTIVE: This protocol describes a cluster randomized controlled trial in 16 primary schools in the Netherlands investigating the effect of BOOSTH on moderate-to-vigorous PA (MVPA) using accelerometry. Secondary aims are to investigate the feasibility of BOOSTH (mixed methods: questionnaires and focus group interviews) and its effect on cardiovascular risk factors (anthropometrics, blood pressure, and retinal microvasculature) and HRQOL. METHODS: Stratification variables and relevant variables related to outcomes (such as BMI [z-score], sex, age, and parenting style) and/or missingness will be taken into account. Measurements will be performed at baseline and after 3, 6, and 12 months. RESULTS: The study has received funding from Province Limburg (SAS-2015-04956) and received ethical approval from the Medical Ethics Committee of Maastricht University Medical Centre (METC172043/NL64324.068.17). The results of the analyses are expected to be published in 2021. CONCLUSIONS: With this study, the ability of the exergame BOOSTH to increase PA and improve health in children of primary school age will be investigated. The insights into effectiveness and feasibility will result in scientific and societal recommendations, which could potentially contribute to widespread implementation of exergames for children. TRIAL REGISTRATION: ClinicalTrials.gov NCT03440580; https://clinicaltrials.gov/ct2/show/NCT03440580. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24035

Feasibility and Effect of the Exergame BOOSTH Introduced to Improve Physical Activity and Health in Children:Protocol for a Randomized Controlled Trial

BACKGROUND: Despite the well-known beneficial health effects of physical activity (PA), the majority of Dutch primary school children do not meet the recommended PA guidelines. Although there is growing evidence on the effectiveness of exergames for PA in children, there is limited evidence on their effect on health outcomes, such as cardiovascular health and health-related quality of life (HRQOL), and on factors influencing their effectiveness and feasibility. The exergame BOOSTH uses a wrist-worn activity tracker to measure steps per day. As a reward for the performed PA, children can unlock levels in the online BOOSTH game. In addition, "BOOSTH battle" enables competition between groups. OBJECTIVE: This protocol describes a cluster randomized controlled trial in 16 primary schools in the Netherlands investigating the effect of BOOSTH on moderate-to-vigorous PA (MVPA) using accelerometry. Secondary aims are to investigate the feasibility of BOOSTH (mixed methods: questionnaires and focus group interviews) and its effect on cardiovascular risk factors (anthropometrics, blood pressure, and retinal microvasculature) and HRQOL. METHODS: Stratification variables and relevant variables related to outcomes (such as BMI [z-score], sex, age, and parenting style) and/or missingness will be taken into account. Measurements will be performed at baseline and after 3, 6, and 12 months. RESULTS: The study has received funding from Province Limburg (SAS-2015-04956) and received ethical approval from the Medical Ethics Committee of Maastricht University Medical Centre (METC172043/NL64324.068.17). The results of the analyses are expected to be published in 2021. CONCLUSIONS: With this study, the ability of the exergame BOOSTH to increase PA and improve health in children of primary school age will be investigated. The insights into effectiveness and feasibility will result in scientific and societal recommendations, which could potentially contribute to widespread implementation of exergames for children. TRIAL REGISTRATION: ClinicalTrials.gov NCT03440580; https://clinicaltrials.gov/ct2/show/NCT03440580. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24035

Associations between physical activity, sedentary time and cardiovascular risk factors among Dutch children

INTRODUCTION: Physical activity (PA) plays an important role in the prevention of cardiovascular diseases, especially in children. Previous studies which investigated the role of PA and sedentary time (ST) in cardiovascular disease used different measurements and found inconsistent results. The current study used recommended standardized measures and provides an overview of PA and ST among Dutch primary school children and their associations with cardiovascular risk factors. METHODS: 503 children (55% girls, mean age (± SD) 10 ± 1y) were included. PA (total PA, lightPA and moderate to vigorous PA (MVPA)) and ST were measured with the Actigraph GT3X accelerometer. PA in different domains was measured with the BAECKE questionnaire. Cardiovascular risk factors included BMI z-score, waist circumference, blood pressure (z-score) and estimated cardiorespiratory fitness (CRF) as measured with the 20 meter shuttle run test. RESULTS: Children spent 57 ± 20 min/day (8%) on MVPA and 42% of the children reached the MVPA guideline of 60 min/day. Total PA and MVPA (h/day) were negatively associated with BMI z-score (B = -0.452, p = 0.011) and waist circumference (B = -3.553, p = 0.011) and positively associated with CRF (B = 2.527, p = <0.001). ST was positively associated with BMI z-score (B = 0.108, p = 0.048) and waist circumference (B = 0.920, p = 0.033). No significant associations were found between total PA or PA intensities and blood pressure. CONCLUSION: This study used standardized measures of PA and therefore created an accurate overview of PA, ST and their associations with cardiovascular risk factors. PA and ST were associated with BMI z-score, waist circumference and CRF. The findings emphasize the importance of promoting MVPA in children, but also highlight the potential benefits of reducing ST to improve cardiovascular risk factors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03440580

Pesten op ‘De Gezonde Basisschool van de Toekomst’: een exploratief onderzoek

To improve the well-being and health of students, several Dutch schools currently implement health promoting lifestyle interventions. To which degree these interventions influence bullying behavior in the school setting is unknown. This mixed methods study examines the influence of a lifestyle intervention at four primary schools (The Healthy Primary School of the Future; HPSF) on bullying. A longitudinal survey among 6th grade students indicated some decrease in bullying at intervention schools compared to control schools (p = .041). Interviews and focus groups conducted with school staff of the intervention schools reveal a decrease in conflicts between children, which most likely also affects bullying. According to the staff, the structural aspects of HPSF create a safer school environment with less opportunity for conflict behavior. This study demonstrates a possible positive (side) effect of a lifestyle intervention on conflicts and bullying. Further research is needed to confirm these observations