BACKGROUND: National health objectives call for improved diet and more regular physical activity among children. We tested the effects of a school-based program to improve students' diet and physical activity behavior at school. METHODS: Two of the four elementary schools in one Texas school district were assigned to intervention and two to control conditions. The three intervention components were classroom health education, vigorous physical education, and lower fat, lower sodium school lunches. Nutrients from school lunches and the total day and the amount of physical activity students obtained during physical education were assessed as outcome. RESULTS: Analysis of school lunches showed declines from base line to posttest in the two intervention schools of 15.5% and 10.4% for total fat, 31.7% and 18.8% for saturated fat, and 40.2% and 53.6% for sodium; posttest values were lower in the intervention schools. Observation of physical activity during physical education classes indicated an increase in the intervention schools from baseline to posttest in the percent of time children engaged in moderate-to-vigorous physical activity from less than 10% of class time at baseline to about 40% of class time at posttest; posttest values were higher in the intervention schools than in the control schools. CONCLUSIONS: This efficacy study demonstrates the feasibility of substantially modifying school lunches and school physical education to improve children's diet and physical activity behavior at school.

The Go For Health Program included classroom health education and environmental changes in school lunch and physical education to foster healthful diet and exercise among elementary school children. Interventions were based on social learning theory and implementation was based on an organizational change strategy for school innovations. Two schools were assigned to intervention and two to control conditions. Cognitive measures (behavioral capability, self-efficacy, behavioral expectations) and self-reported diet and exercise behavior were assessed at baseline and following intervention. Data were analyzed by ANOVA using the student and then the school as the unit of analysis. Statistically significant changes were observed for diet behavioral capability, self-efficacy, and behavioral expectations, use of salt, and exercise behavioral capability (fourth grade), self-efficacy (fourth grade) and frequency of participation in aerobic activity. The results provide evidence for program impact on learning outcomes and student behavior.

Third and fourth grade boys (n = 422) and girls (n = 390) in four Texas elementary schools reported their participation in moderate to vigorous physical activities (MVPAs) over a 3-day period. Students were surveyed during class on successive days. On a subsample (n = 44), the agreement between reported and observed physical activities during physical education or recess was 86.3%. Running, walking fast, games and sports, and bicycling accounted for 70% of Total MVPAs. Of Total MVPAs reported, 47.0% for boys and 44.6% for girls were 10 min or longer in duration (LMVPA). The average number of LMVPAs per day was 1.7 for both boys and girls. Students reported significantly more occurrences of LMVPAs out of school than during school. Significant interaction between grade and gender indicated that third grade boys reported more Total MVPAs and LMVPAs than third grade girls, but fourth grade boys reported fewer Total MVPAs and LMVPAs than fourth grade girls reported fewer Total MVPAs and LMVPAs than fourth grade girls. During the 3-day reporting period, 12.3% of boys and 13.3% of girls reported no LMVPAs, and 35.6% of boys and girls reported fewer than one LMVPAs per day. While the majority of children reported obtaining at least some activity daily, a substantial proportion of children in this sample reported fewer than one LMVPA daily, indicating that many children may not be obtaining adequate amounts of physical activity.

In the Go For Health project, interventions based on organizational change and social learning theory facilitate changes in diet and exercise behavior by elementary school children. Baseline data documented the need for behavior change. Based on chemical analyses, average per meal amounts of total fat and sodium were higher than national recommendations: total fat was 29.3% higher than U.S. Dietary Goals; sodium was 107.4% greater than recommended levels. Observations of students in physical education class revealed children moved through space 50.1% of the time and moved continuously an average of 2.2 minutes per class period. These findings suggest the need for policy and practice changes in the school environment to enable children to engage in more healthful diet and exercise behavior.

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