A socio-ecological approach promoting physical activity and limiting sedentary behavior in adolescence showed weight benefits maintained 2.5 years after intervention cessation

Abstract

Background:Obesity in youth remains a major public health issue. Yet no effective long-term preventive strategy exists. We previously showed that a school-based socio-ecological approach targeting behavior and social/environmental influences on physical activity (PA) prevented 4-year excessive weight gain in 12-year olds. In this study, we investigated if this efficacy persists 30 months after intervention cessation.Methods and Findings:The program targeted students, family, school and the living environment to promote/support PA and prevent sedentary behavior (SB). A total of 732 students from eight randomized middle schools completed the 4-year trial. At the 30-month post-trial follow-up, body mass index (BMI), fat mass index (FMI), leisure PA (LPA), home/school/workplace active commuting, TV/video time (TVT), and attitudes toward PA were measured in 531 adolescents. The beneficial effects of the intervention on the excess BMI increase (+0.01 vs +0.34 kg m−2 in the intervention and control groups, respectively) and on the overweight incidence in initially non-overweight students (4.3% vs 8.6% odds ratio=0.48 (95% confidence interval: 0.23–1.01)) were maintained at the post-trial follow-up. LPA was not maintained at the level achieved during the trial. However, we still observed a prevention of the age-related decrease of the adolescents' percentage reporting regular LPA (−14.4% vs −26.5%) and a higher intention to exercise in the intervention group. The intervention promoted lower TVT (−14.0 vs +13.6 min per day) and higher active commuting changes (+11.7% vs −4.8%). Trends in higher BMI reduction in students with high initial TVT and in the least wealthy group were noted. TVT changes throughout the follow-up predicted excess BMI and FMI changes.Conclusions:Long-term multilevel approach targeting PA and SB prevents excessive weight gain up to 30 months after intervention cessation. The efficacy may be higher in the most sedentary and least wealthy adolescents. Healthy PA-related behavior inducing long-lasting weight effects can be promoted in youth providing that an ecological approach is introduced in the prevention strategy.

Temporal Trends in Overweight and Obesity, Physical Activity and Screen Time among Czech Adolescents from 2002 to 2014: A National Health Behaviour in School-Aged Children Study

“…The association between excessive TV watching and clustered metabolic risk is mediated by adiposity, whereas lack of PA is associated with individual metabolic-risk indicators independently of obesity [ 70 ]. Therefore, in agreement with the conclusions of the above mentioned studies [ 68 , 69 , 70 , 71 ] the results of our study highlight the need for current intervention strategies aimed at reducing excessive body weight—a multilevel approach involving energy balance-related behaviour (PA, sedentary and dietary behaviour) in school and family-friendly environments [ 72 , 73 , 74 , 75 ]. A long-term multilevel approach targeted at increasing PA and reducing sedentary behaviour prevents excessive weight gain, not only during the course of multilevel interventions [ 34 , 74 ], but also more than two years after its cessation [ 35 , 75 ].…”

The Longitudinal Impact of NFL PLAY 60 Programming on Youth Aerobic Capacity and BMI

“…The current study also confirms that multilevel school-driven programs are more efficacious than individual or interpersonal PA interventions. 7,29 Teachers and school leaders can successfully lead these type of programs but efforts are likely influenced by system-level practices in districts and by local school administrators.…”

“…4,6 Recent review studies indicate that interventions utilizing comprehensive school-based models, environmental changes, and multicomponent programs are more effective than other interventions. 6,7 In addition, interventions coordinating efforts from multiple community organizations or partners have demonstrated greater capacity to increase PA. 8 Despite this evidence of effectiveness, it has proven difficult to systematically disseminate programs on a large scale. 9 National initiatives such as Let's Move!…”

Associations between Public Transport Accessibility around Homes and Schools and Walking and Cycling among Adolescents

“…The health benefits of physical activity in preventing life-threatening chronic diseases including cardiovascular diseases, obesity, diabetes and cancer is well established [1][2][3][4][5][6]. Separate health guidelines exist for physical activity for children and adolescents compared to adults.…”