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Impressum

Baden-Württemberg Stiftung gGmbH
Kriegsbergstraße 42
70174 Stuttgart
Deutschland

Fon +49.711.248 476-0
Fax +49.711.248 476-50
E-Mail: info(a)bwstiftung.de

www.bwstiftung.de

Vertretungsberechtigte Geschäftsführung: Christoph Dahl (Geschäftsführer), Rudi Beer, Dr. Andreas Weber, Birgit Pfitzenmaier (Prokuristen)
Gesellschafter: Land Baden-Württemberg
Handelsregistereintrag: Amtsgericht Stuttgart HRB 10775

Map of Baden-Württemberg with its kindergartens taking part in the Health Survey

For the evaluation of this multi-level multi-component programme, a prospective, stratified, cluster randomised and longitudinal study was performed with an intervention group and a control group. After completion of baseline measurements, the programme Join the Healthy Boat was carried out in the intervention group, while the control group followed the regular kindergarten day-to-day life with no contact during that year. Follow-up measurements took place after one year. Details on kindergarten and participants’ recruitment, materials and organisation of randomisation and data collection can been found elsewhere (Kobel et al., 2017).

973 kindergarten children in 57 kindergartens (30 kindergartens in the intervention group; 27 kindergartens in the control group), who participated in the evaluation study of the programme were assessed at baseline and 558 (57%) of them at follow-up. Prior to data collection, parents provided written and informed consent and children their assent to taking part in the study.

 

 

 

 

Physical activity is associated with a number of positive mental and physical health outcomes (Timmons et al., 2012; Timmons et al., 2007) and has also been shown to track throughout childhood (Kelder et al., 1994; Reilly et al., 2004; Jones et al., 2013). Therefore, the World Health Organization (WHO) recommends that children spend at least 60 min of moderate to vigorous physical activity (MVPA) daily (WHO, 2019; WHO, 2020).

One aim of the programme Join the Healthy Boat is to increase children’s (everyday) physical activity. Therefore, parents were questioned about their children’s physical activity behaviours.

At baseline, children spent on 2.7(±2.0) days/week 1 h or more in MVPA. 7.2% of children reached 60 min of MVPA on seven days per week. There was a significant gender difference in days being sufficiently physically active (p≤0.001) with boys spending on average 2.9 (±2.1) days/week with at least 60min of MVPA, whereas girls spent on 2.3 (±1.8) days/week 1h in that intensity.

One year later, at follow-up, children engaged in 60 min of MVPA on 2.8 (±2.0) days/week and reached that hour of MVPA on 7days/week significantly more often than the year before (p≤0.001).

A significant difference could be observed between control and intervention group with children in the intervention group spending significantly more days engaging in 60 min of MVPA than children in the control group (p≤0.005), which stayed significant even when controlling for baseline values, age, gender, weight status and migration status.

Also, there were proportionally nearly twice as many children in the intervention group who were physically active on every day of the week, compared to the control group (p≤0.03). This was the case although at baseline, less children in the intervention group engaged in 60 min of MVPA on seven days per week than in the control group.

 

For more details, see Kobel et al., 2019

 

Figure 1: Percentage of children achieving 60 minutes of moderate to vigorous physical activity (MVPA) per day

Endurance capability

Regular physical activity improves movement skills in kindergarten children (Reilly et al., 2006). Especially the time between three and six years is an essential period for children's motor development, since children then improve their basic motor abilities, such as speed, endurance, strength, coordination and balance (Sentderdi, 2008), which are bases for many physical activities (Gallahue et al., 2006) and may even influence their later physical activity behaviours (Barnett et al., 2009; Stodden et al., 2009).

Endurance capability was assessed using a 3-minute-run (Oja and Jürimäe, 1997) which the children performed during a visit at their kindergarten, supervised and instructed by trained staff.

At baseline, children ran between 98 and 435m in 3min (251.5 ± 45.7m), largely depending on age (p≤0.001) and gender (p≤0.03).

After the one-year intervention, the distance children covered in their three-minute run ranged from 151 to 486m (297.8 ± 45.9m), still predominantly depending on age (p≤0.001) and gender (p≤0.01).

There was a significant intervention effect with children in the intervention group reaching 305.8 (±46.2) m in 3min and those in the control group covering 286.9 (±43.2) m, although baseline values were slightly higher in the control group compared to the intervention group (252.8 ± 45.7m and 250.7 ± 48.9m, respectively).

Therefore, children in the intervention group performed significantly better in the three-minute endurance run than their counterparts in the control group, even if adjusted for baseline values, age, gender, weight status, and migration status (p≤0.001).

 

 

For more details on other motor skills, see Lämmle et al., 2017

 

 

Figure 2: Change in the distance covered in the 3-minute run

Fruit and Vegetable consumption

Sufficient physical activity and a well-balanced diet are essential for normal growth and development (Hills et al., 2007) and play an important role in the prevention of increased weight and obesity (Strong et al., 2005). Research shows that especially the consumption of sugar-sweetened beverages has been identified as the most consistent dietary factor, which is associated with subsequent increases in weight status and fatness in children (Must et al., 2009).

One aim of the programme Join the Healthy Boat is to increase children’s fruit and vegetables intake and to reduce their consumption of sugar-sweetened beverages. Therefore, dietary patterns were assessed using a parental questionnaire.

At baseline, children ate 2.27 (±1.73) portions of fruit and vegetables daily with 16.7% of children eating no fruit or vegetables and 9.9% of children eating five or more portions per day.

At follow-up, children ate 2.39 (±1.81) portions of fruit and vegetables per day with 17.9% of children eating no fruit or vegetables and 10.9% of children eating five or more portions daily.

There was no significant difference between control and intervention group at baseline or follow-up.

 

Consumption of sugar-sweetened beverages

Before intervention, 24.6% of children never drank any sugar-sweetened beverages, 9.5% drank bespoke drinks at least once per day with no significant difference between control and intervention group but with a slight tendency towards greater daily sugar-sweetened beverage consumption in the intervention group (10.7% vs. 7.9% for intervention and control group, respectively).

After one year, 21.2% of children never consumed and sugar-sweetened beverages, 6.2% of children drank those beverages at least once daily with no significant difference between control and intervention group.

However, children in the intervention group displayed higher values of daily consumption of sugar-sweetened beverage at baseline, compared to the children in the control group; after one year, the percentage of children in the intervention group who consumed sugar-sweetened beverages at least daily reduced to 5.9% whereas the percentage of children in the control group whose parents reported to consume sugar-sweetened beverages at least daily remained the same (7.9%).

 

 

For more details, see Kobel et al., 2019

 

 

Figure 3: Proportion of children who drink sugar-sweetened beverages once or several times a day

Leisure time preferences

Insufficient physical activity and too much sedentary time have been associated with poor physical and mental health (Carson et al., 2016; Biddle et al., 2011; Katzmarzyk et al., 2017). In children, an increased risk of obesity, impaired glucose metabolism, cardiovascular disease, high blood pressure and cholesterol, depression and anxiety have been associated with sedentary behaviour (Carson et al., 2016; Biddle et al., 2011; Katzmarzyk et al., 2017; De Moraes et al., 2015; Sivanesan et al., 2020). Although evidence of such associations of sedentary time in children is mainly limited to screen time (Carson et al., 2016), sedentary behaviour has been shown to track into adolescence and adulthood (Biddle et al., 2010; Hancox et al., 2004). Environmental changes and advances in technology, have resulted in sedentary behaviour being present within all age groups and settings of daily life.

One aim of Join the Healthy Boat is to reduce children’s screen media use by offering active choices and action alternatives. Screen media behaviour was assessed using a parental questionnaire, children’s preferences were assessed by children using picture cards to indicate whether they prefer to be active or prefer to sit, watch television or play computer games.

In the control group, the preference for physical activity and sports in all categories decreased from baseline to follow-up. In the intervention group however, the preference for physical activity and sports increased.

The figure below shows the preferences of the control and intervention group for baseline and follow-up.

 

 

Screen media use

At baseline, 49.5% of children used screen media (television, game console, computer, tablet, smartphone) for 1h or more per day.

At follow-up this increased to 54.2% with no significant difference between control and intervention group.

For more details, see Kobel et al., 2019

 

 

Figure 4: Preference physical activity vs. using screen media

Diet, lifestyle factors, screen media use and physical activity, and many more factors can influence the weight status of children (Olds et al., 2010), because of this it was objectively assessed during a visit to the kindergartens.

Anthropometric measurements such as children's height (cm) and body mass (kg) were taken by trained technicians using a stadiometer and calibrated electronic scales. Children's BMI was calculated as weight divided by height squared and converted to BMI percentiles (BMIPCT) using German reference data (Kromeyer-Hauschild et al., 2001).

Average BMIPCT of participating children at baseline were 50.3 (±25.9) with no significant differences between gender or migration background. 5.8% of children were classified as overweight (including obesity) and 2.5% as obese.

At follow-up, this changed marginally to 6.5% of children being overweight (including obesity) and 2.4% of children being obese.

Although, children in the intervention group displayed slightly higher BMIPCT values at baseline, compared to the children in the control group (51.9 ± 25.9 and 47.9 ± 25.9, respectively), after one year, BMIPCT values of children in the intervention group decreased to 48.7 (±26.3) whereas BMIPCT values of children in the control group increased to 48.4 (±26.2).

Taking into account age, gender and baseline values, this shows a significant positive intervention effect (p≤0.04), however, once controlled for migration background, this effect was lost.

Figure 5: Development of BMI percentiles