Helge Hebestreit

Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial

Objective To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren. Design Cluster randomised controlled trial. Setting 28 classes from 15 elementary schools in Switzerland randomly selected and assigned in a 4:3 ratio to an intervention (n=16) or control arm (n=12) after stratification for grade (first and fifth grade), from August 2005 to June 2006. Participants 540 children, of whom 502 consented and presented at baseline. Intervention Children in the intervention arm (n=297) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week, daily short activity breaks, and physical activity homework. Children (n=205) and parents in the control group were not informed of an intervention group. For most outcome measures, the assessors were blinded. Main outcome measures Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). Secondary outcome measures included body mass index and cardiovascular risk score (average z score of waist circumference, mean blood pressure, blood glucose, inverted high density lipoprotein cholesterol, and triglycerides). Results 498 children completed the baseline and follow-up assessments (mean age 6.9 (SD 0.3) years for first grade, 11.1 (0.5) years for fifth grade). After adjustment for grade, sex, baseline values, and clustering within classes, children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds (−0.12, 95 % confidence interval −0.21 to −0.03; P=0.009). Likewise, their z scores for aerobic fitness increased more favourably (0.17, 0.01 to 0.32; P=0.04), as did those for moderate-vigorous physical activity in school (1.19, 0.78 to 1.60; P<0.001), all day moderate-vigorous physical activity (0.44, 0.05 to 0.82; P=0.03), and total physical activity in school (0.92, 0.35 to 1.50; P=0.003). Z scores for overall daily physical activity (0.21, −0.21 to 0.63) and physical quality of life (0.42, −1.23 to 2.06) as well as psychological quality of life (0.59, −0.85 to 2.03) did not change significantly. Conclusions A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children. Trial registration Current Controlled Trials ISRCTN15360785.

Is there a secular decline in motor skills in preschool children

Current research seems to confirm a secular decline in movement skills in school children. Only few data are available for preschool children and no clear trend can be identified. In the year 2007, height, weight, and motor performance were determined in 726 preschool children [Prevention through Activity in Kindergarten Trial (PAKT)] and compared with historical samples from 1973, 1985, and 1989. There was no difference in height and weight between the samples of 1973 and 2007. Older boys of today were smaller and lighter than those of 1989. Regardless of age, PAKT children fared significantly better in standing long jump than those assessed in 1989. Compared with the sample of 1973, PAKT children did equally well in this task. There were no differences in performance in an obstacle course between children of 1989 and 2007. In balancing backwards, PAKT children performed significantly worse than those in 1985. Regarding target throwing only the PAKT 4‐year‐olds achieved significantly worse results than those in 1985.Therefore, in preschool children, a secular decline is only evident in some, but not all, motor skills, which may indicate a change in behavior activity over the last decades.

Long-Term Effect of a School-Based Physical Activity Program (KISS) on Fitness and Adiposity in Children: A Cluster-Randomized Controlled Trial

Background School-based intervention studies promoting a healthy lifestyle have shown favorable immediate health effects. However, there is a striking paucity on long-term follow-ups. The aim of this study was therefore to assess the 3 yr-follow-up of a cluster-randomized controlled school-based physical activity program over nine month with beneficial immediate effects on body fat, aerobic fitness and physical activity. Methods and Findings Initially, 28 classes from 15 elementary schools in Switzerland were grouped into an intervention (16 classes from 9 schools, nu200a=u200a297 children) and a control arm (12 classes from 6 schools, nu200a=u200a205 children) after stratification for grade (1st and 5th graders). Three years after the end of the multi-component physical activity program of nine months including daily physical education (i.e. two additional lessons per week on top of three regular lessons), short physical activity breaks during academic lessons, and daily physical activity homework, 289 (58%) participated in the follow-up. Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). After adjustment for grade, gender, baseline value and clustering within classes, children in the intervention arm compared with controls had a significantly higher average level of aerobic fitness at follow-up (0.373 z-score units [95%-CI: 0.157 to 0.59, pu200a=u200a0.001] corresponding to a shift from the 50th to the 65th percentile between baseline and follow-up), while the immediate beneficial effects on the other primary outcomes were not sustained. Conclusions Apart from aerobic fitness, beneficial effects seen after one year were not maintained when the intervention was stopped. A continuous intervention seems necessary to maintain overall beneficial health effects as reached at the end of the intervention. Trial Registration ControlledTrials.com ISRCTN15360785

Exercise-induced hypoxemia and cardiac arrhythmia in cystic fibrosis

BACKGROUNDnPhysical activity has become part of the therapy of patients with cystic fibrosis (CF) despite possible risks. The objectives of this study were to identify predictors of hypoxemia and to search for cardiac arrhythmia during exercise.nnnMETHODSnThe data of 75 patients (12 to 41 years old) with CF who underwent a standardized incremental exercise test on a cycle ergometer was analyzed. Oxygen saturation (SpO(2)) and ECG were monitored. The results were related to spirometric and SpO(2) measurements at rest.nnnRESULTSnDuring exercise, 17 patients suffered from significant desaturations (SpO(2)<90%). SpO(2) at peak exercise was independently related to SpO(2) at rest and 1/FEV1 (multiple regression R(2)=0.63). Five patients demonstrated ventricular arrhythmias during exercise. No unambiguous prediction of exercise-induced hypoxemia or cardiac arrhythmia was possible.nnnCONCLUSIONnIn order to detect all patients with exercise-induced hypoxemia and cardiac arrhythmia, an incremental exercise test to volitional fatigue must be performed.

Prevention through Activity in Kindergarten Trial (PAKT) : a cluster randomised controlled trial to assess the effects of an activity intervention in preschool children

BackgroundPhysical activity and motor skills acquisition are of high importance for health-related prevention and a normal development in childhood. However, few intervention studies exist in preschool children focussing on an increase in physical activity and motor skills. Proof of positive effects is available but not consistent.Methods/DesignThe design, curriculum, and evaluation strategy of a cluster randomised intervention study in preschool children are described in this manuscript. In the Prevention through Activity in Kindergarten Trial (PAKT), 41 of 131 kindergartens of Wuerzburg and Kitzingen, Germany, were randomised into an intervention and a control group by a random number table stratified for the location of the kindergarten in an urban (more than 20.000 inhabitants) or rural area. The aims of the intervention were to increase physical activity and motor skills in the participating children, and to reduce health risk factors as well as media use. The intervention was designed to involve children, parents and teachers, and lasted one academic year. It contained daily 30-min sessions of physical education in kindergarten based on a holistic pedagogic approach termed the early psychomotor education. The sessions were instructed by kindergarten teachers under regular supervision by the research team. Parents were actively involved by physical activity homework cards. The kindergarten teachers were trained in workshops and during the supervision. Assessments were performed at baseline, 3-5 months into the intervention, at the end of the intervention and 2-4 months after the intervention. The primary outcomes of the study are increases in physical activity (accelerometry) and in motor skills performance (composite score of obstacle course, standing long jump, balancing on one foot, jumping sidewise to and fro) between baseline and the two assessments during the intervention. Secondary outcomes include decreases in body adiposity (BMI, skin folds), media use (questionnaire), blood pressure, number of accidents and infections (questionnaire), increases in specific motor skills (throwing, balancing, complex motor performance, jumping) and in flexibility.DiscussionIf this trial proofs the effectiveness of the multilevel kindergarten based physical activity intervention on preschoolers activity levels and motor skills, the programme will be distributed nationwide in Germany.Trial RegistrationClinicalTrials.gov Identifier: NCT00623844

Pulmonary fibrosis in youth treated with radioiodine for juvenile thyroid cancer and lung metastases after Chernobyl

PurposeThe objective of this project was to systematically determine the prevalence and consequences of pulmonary fibrosis in youth with thyroid carcinoma and lung metastases from Belarus who were treated with radioiodine (131I).MethodsA total of 69 patients treated for juvenile thyroid carcinoma and lung metastasis with 131I were assessed. A group of 29 patients without lung metastases and prior 131I treatment served as controls. The assessments included a CT scan of the lungs, extensive pulmonary function testing and an incremental cycle test to volitional fatigue with measurements of oxygen uptake (

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O2), oxygen saturation and alveolar-arterial difference in oxygen partial pressure (ΔaaO2).ResultsFive patients with lung metastases showed advanced pulmonary fibrosis on CT scans and also had poorer lung functions compared with the 62 patients with none or minor signs of fibrosis and the 29 controls. Furthermore, these five patients showed lower peak