Comparison of two school-based programmes for health behaviour change: the Belo Horizonte Heart Study randomized trial

Abstract

Objective: To assess the efficacy of two school-based programmes to promote students' willingness to engage in lifestyle changes related to eating habits and physical activity behaviours. Design: Elementary school-based health promotion intervention, designed as a multicomponent experimental study, based on a behavioural epidemiological model. Setting: Nine intervention and eight comparative public and private elementary schools. Subjects: The goal was to determine the impact on the longitudinally assessed outcomes of two programmes that addressed healthy nutrition and active living in a cohort of 2038 children. The evaluations used pre-intervention and follow-up student surveys that were based on the Transtheoretical Model of the stages of behaviour change. Results: In the intervention group, there were significant (P , 0?001) differences between the pre-and post-intervention times in the stages of change, with a reduction in the percentage of children at the pre-contemplation and contemplation stages and increased percentages at the preparation, action and maintenance stages, leading to healthier behaviours in fatty food consumption, fruit and vegetable consumption, physical activity and time spent in sedentary activities. The determinants of the behaviour stage were the intervention programme, the type of school and the presence of motivated teachers. The comparison group did not show significant differences between the pre-and post-intervention times for any of the stages of behaviour. Conclusions: The intervention programme encouraged the students to make healthy lifestyle choices related to eating habits and physical activity behaviours. Keywords Healthy lifestyleOverweight Obesity School Children PreventionOverweight and obesity (excess body weight) has increased dramatically in southern Latin America (1) . In south-eastern Brazil 40?3 % of boys and 38?0 % of girls are overweight or obese (2) . There has been a threefold increase in the incidence of excess body weight (8?9 % to 26?5 %) from 1974-75 to 2008-09 (2) . This increase in childhood overweight and obesity has been attributed to behavioural factors that cause a long-term imbalance between energy intake and energy expenditure. Behavioural problems require behavioural solutions (3,4) and therefore prevention of excess body weight through targeted behavioural change has become a public health priority (5,6) .In Brazil, consumption of energy-dense, high-fat foods has increased to above recommended levels, while physical activity (PA) and consumption of fruit and vegetables (F&V) have fallen well below the recommended levels (7) .These behaviours have resulted in an increase in obesityrelated co-morbidities such as IHD, stroke and diabetes, which account for a high percentage of total disabilityadjusted life years lost (8) . Sedentary lifestyles account for 69 % of the cardiovascular risk factor prevalence in Brazil (9) .Suggested behavioural solutions include increased moderate-to-vigorous PA among school-aged children and reduced sedentary t...

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