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Effectiveness of a physical activity intervention in preschoolers: A cluster-randomized controlled trial
Claudia Hacke1, Sascha Ketelhut2, Ulrike Wendt3
1Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Preschool exercise programs did not significantly impact overall hemodynamic factors. However, children from lower socioeconomic backgrounds showed reduced blood pressure and improved vascular function after the intervention.
Area of Science:
- Pediatric Health
- Cardiovascular Physiology
- Public Health Interventions
Background:
- Limited research exists on the hemodynamic effects of preschool activity interventions.
- Understanding the impact on blood pressure and vascular function is crucial for early health.
- Socioeconomic disparities may influence the effectiveness of such programs.
Purpose of the Study:
- To evaluate a preschool exercise program's effectiveness on blood pressure and vascular function in young children.
- To investigate potential differences in outcomes based on socioeconomic background.
- To assess effects on anthropometrics, physical activity, and motor skills.
Main Methods:
- A cluster-randomized controlled trial involving 135 preschoolers (ages 3-6) across 5 preschools.
- Intervention group received 6 months of twice-weekly, 45-minute exercise lessons.
- Outcomes included peripheral and central blood pressure, pulse wave velocity, BMI, and motor skills, with maternal education indicating socioeconomic status.
Main Results:
- The 6-month exercise program did not show significant overall effects on primary or secondary hemodynamic, anthropometric, or motor skill outcomes.
- A significant reduction in the increase of peripheral systolic blood pressure, central systolic blood pressure, and pulse wave velocity was observed in children from lower socioeconomic backgrounds.
- No significant benefits were noted for children from higher socioeconomic backgrounds.
Conclusions:
- A 6-month preschool-based exercise program demonstrated no overall effectiveness on hemodynamics, anthropometrics, activity, or motor skills.
- However, the intervention showed potential benefits for children from lower socioeconomic backgrounds, specifically in reducing blood pressure and improving vascular markers.
- Further research with robust process evaluations and fidelity measures is needed to confirm these findings and understand causal relationships.
Abstract:
Several activity interventions in preschool settings exist, but little attention has been paid to effects on hemodynamic factors. The study aimed to assess the effectiveness of an exercise program on health-related outcomes including blood pressure (BP) and markers of vascular function in preschoolers, with focus on socioeconomic background. This study is a cluster-randomized controlled trial, with preschool as unit of randomization and children as unit of analysis. Preschools with 3- to 6-year-old children, stratified by social area, were randomly allocated to: intervention (three clusters, n = 92) including 2 d·wk-1 /45 min (6 months) exercise lessons or control (two clusters, n = 43). In total, 135 children (4.8 ± 0.8 y) had minimum one outcome measurement at baseline and follow-up. Primary outcome: peripheral BP. Secondary outcomes: central BP, pulse wave velocity (PWV), BMI, waist circumference, physical activity measures, motor skills. Maternal education was used as an indicator of socioeconomic status. Mixed models were applied to evaluate differences in mean change. Group allocation had no effect on primary or secondary outcomes. However, the intervention was effective in reducing increases in peripheral systolic BP (-3.4 mm Hg; 95% CI: -6.6; -0.2; P = 0.037), central systolic BP (-3.8 mm Hg; -6.4; -1.1; P = 0.006), and PWV (-0.1 m/s; -0.2; -0.0; P = 0.045) among children whose mothers had the lowest educational level. We found no evidence for effectiveness of a 6-months preschool-based exercise program on hemodynamics, anthropometrics, activity, or motor skills, but lack of process evaluations and poor fidelity preclude interpretation of the causal relation. However, the results indicate that children from lower social backgrounds could benefit from early exercise-promoting interventions.
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