一项“基于学校”的体育活动干预对经济弱势社区青少年肥胖的影响：“全民体育活动”随机对照试验的次要结果
Effects of a 'school-based' physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the 'Physical Activity 4 Everyone' RCT.
作者信息
Hollis J L, Sutherland R, Campbell L, Morgan P J, Lubans D R, Nathan N, Wolfenden L, Okely A D, Davies L, Williams A, Cohen K E, Oldmeadow C, Gillham K, Wiggers J
机构信息
Hunter New England Population Health, The University of Newcastle, Wallsend, New South Wales, Australia.
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
出版信息
Int J Obes (Lond). 2016 Oct;40(10):1486-1493. doi: 10.1038/ijo.2016.107. Epub 2016 Jun 10.
BACKGROUND/OBJECTIVES: Obesity prevention during adolescence is a health priority. The 'Physical Activity 4 Everyone' (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities. This paper aimed to report the secondary outcomes of the study; to determine whether the intervention impacted on adiposity outcomes (weight, body mass index (BMI), BMI z-score), and whether any effect was moderated by sex, baseline BMI and baseline physical activity level, at 12 and 24 months.
SUBJECTS/METHODS: A cluster randomised controlled trial was conducted in New South Wales, Australia. The school-based intervention included seven physical activity strategies targeting the following: curriculum (strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme); school environment (physical activity during school breaks, modification of school policy); and parents and the community (parent engagement, links with community physical activity providers). Students' weight (kg), BMI and BMI z-score, were collected at baseline (Grade 7), 12 and 24 months. Linear Mixed Models were used to assess between-group mean difference from baseline to 12 and 24 months. Exploratory sub-analyses were undertaken according to three moderators of energy balance.
RESULTS
A total of 1150 students (mean age=12 years) provided outcome data at baseline, 1051 (91%) at 12 months and 985 (86%) at 24 months. At 12 months, there were group-by-time effects for weight (mean difference=-0.90 kg (95% confidence interval (CI)=-1.50, -0.30), P<0.01) and BMI (-0.28 kg m (-0.50, -0.06), P=0.01) in favour of the intervention group, but not for BMI z-score (-0.05 (-0.11; 0.01), P=0.13). These findings were consistent for weight (-0.62 kg (-1.21, 0.03), P=0.01) and BMI (-0.28 kg m (-0.49, -0.06), P=0.01) at 24 months, with group-by-time effects also found for BMI z-score (-0.08 (-0.14; -0.02), P=0.02) favouring the intervention group.
CONCLUSION
The PA4E1 school-based intervention achieved moderate reductions in adiposity among adolescents from socio-economically disadvantaged communities. Multi-component interventions that increase adolescents' engagement in moderate-to-vigorous physical activity (MVPA) may assist in preventing unhealthy weight gain.
背景/目的：预防青少年肥胖是一项健康优先事项。“全民体育活动”（PA4E1）研究在10所来自社会经济弱势社区的中学测试了一项多成分体育活动干预措施。本文旨在报告该研究的次要结果；确定该干预措施是否对肥胖结果（体重、体重指数（BMI）、BMI z评分）产生影响，以及在12个月和24个月时，性别、基线BMI和基线体育活动水平是否对任何影响有调节作用。
受试者/方法：在澳大利亚新南威尔士州进行了一项整群随机对照试验。基于学校的干预措施包括针对以下方面的七种体育活动策略：课程（在体育教育中最大化体育活动的策略、学生体育活动计划、强化学校体育项目）；学校环境（课间体育活动、修改学校政策）；以及家长和社区（家长参与、与社区体育活动提供者建立联系）。在基线（7年级）、12个月和24个月时收集学生的体重（千克）、BMI和BMI z评分。使用线性混合模型评估从基线到12个月和24个月的组间平均差异。根据能量平衡的三个调节因素进行探索性亚分析。
结果
共有1150名学生（平均年龄 = 12岁）在基线时提供了结果数据，1051名（91%）在12个月时提供了数据，985名（86%）在24个月时提供了数据。在12个月时，体重（平均差异 = -0.90千克（95%置信区间（CI） = -1.50， -0.30），P < 0.01）和BMI（-0.28千克/米（-0.50， -0.06），P = 0.01）存在组×时间效应，有利于干预组，但BMI z评分（-0.05（-0.11；0.01），P = 0.13）不存在。在24个月时，体重（-0.62千克（-1.21，0.03），P = 0.01）和BMI（-0.28千克/米（-0.49， -0.06），P = 0.01）的这些结果是一致的，BMI z评分（-0.08（-0.14； -0.02），P = 0.02）也存在组×时间效应，有利于干预组。
结论
PA4E1基于学校的干预措施使社会经济弱势社区的青少年肥胖适度降低。增加青少年参与中度至剧烈体育活动（MVPA）的多成分干预措施可能有助于预防不健康的体重增加。
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