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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 schools taking part in the Baden-Württemberg Study

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 school curriculum with no contact during that year. Follow-up measurements took place after one year. Details on school and participants’ recruitment, materials and organisation of randomisation and data collection can been found elsewhere (Dreyhaupt et al., 2012).

1,943 primary school children in 157 classes from all parts of Baden-Württemberg, who participated in the evaluation study of the programme were assessed at baseline. Prior to data collection, parents provided written and informed consent and children their assent to taking part in the study.

 

 

 

 

 

 

 

 

 

 

 

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 6-minute-run (as part of the Dordel Koch Test; Dordel & Koch, 2004) which the children performed during a visit at their school, supervised and instructed by trained staff.

At baseline, children ran an average of 851.39 (± 119.21) m during the 6-minute run, with a significant difference of 13.55 (± 5.77) m between the intervention and control group (p = 0.019). In addition, there was a gender difference in which boys covered significantly more meters (51.56 ± 5.59 m; p <0.001) in six minutes than girls; and a significant age difference since second graders ran significantly further (49.03 ± 5.64 m; p <0.001) than first graders.

After one year, children reached an average of 65.41 (± 119.31) m more in six minutes than in the previous year, namely 917.33 (± 131.51) m. Having completed 17 (± 106.59) m more than in the previous year, the children in the intervention group tended to improve their performance more (70.51 ± 128.62 m; p = 0.046).

The gender and age difference observed at baseline with regard to the result of the 6-minute run remained during follow-up: boys and third graders (formerly second graders) reached 952.23 (± 134.20) m and 935.39 (± 124.65) m significantly higher results than the girls and children in second grade (formerly first grade; girls: 881.10 ± 118.29 m and second graders: 900.83 ± 135.45 m; p ≤ 0.001).

 

 

For more details, see Kobel et al., 2019

 

 

Figure 3: Increase in endurance capacity from initial to follow-up examination in meters (6-minute run); for first and second graders; *) significant difference.

Motor skills

Further results on motor abilities indicate that children in the intervention group show a significant improvement in their energetically determined (conditional) abilities compared to the children in the control group, as well as a smaller decline in mobility (Lämmle et al., 2016). In addition, an improvement in mobility was observed for the girls in the intervention group (Lämmle et al., 2016). The table below lists the DKT sport motor tests performed and the follow-up-baseline differences.

In addition, as a measure of comparison between the intervention group and the control group, the difference between the performance for follow-up measurement and the performance at baseline, i.e. the increase during the academic year, was evaluated individually. In the intervention group, endurance performance increased significantly compared to the control group.

 

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

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 skipping breakfast is associated with higher rates of overweight and obesity in children (Vanelli et al., 2005) and 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.

Fruit and vegetable consumption was significant for children with migration background. Data on children’s fruit and vegetable intake at school revealed that at baseline 2.9 and 20.6 % of children with migration background never or rarely eat fruit and vegetables during their break and lunch times, respectively. There was a significant gender difference with 19.2 % of girls and 27.1 % of boys never or rarely eating fruit and vegetables at school (p = 0.043).

At baseline, no difference between control and intervention group was found; after 1 year of intervention, logistic regression analyses revealed no difference between the two groups (OR 1.663 [0.895; 3.090]; p = 0.108).

Significant positive effects however could be observed when analysing data using a related-samples marginal homogeneity test with children with migration background in the intervention group eating fruit and vegetables significantly more often than children with migration background in the control group (children who never or rarely eat fruit and vegetables at school in the intervention group: 25.4 % at baseline, 18.0 % at follow-up; control group: 20.5 % at baseline, 20.5 % at follow-up; p = 0.035).

 

For more details, see Kobel et al., 2017

Figure 4: Changes (in percentage) in categories of fruit and vegetable intake at school between baseline and follow-up for intervention and control group for children with migration background

 

Consumption of sugar-sweetened beverages

Investigating children’s soft drink consumption, at baseline, 24.6% of boys and 22.6% of girls drank sugar-sweetened beverages at least once per week. Neither a significant gender difference nor a difference between control and intervention groups could be observed at baseline.

Similarly, at follow-up, there was no significant difference between control and intervention groups. Even though, a reduction of soft drink consumption could be seen in both groups. However, the decline in the intervention group was by trend greater than that in the control group.

 

 

Figure 5: Percentage of children who drink beverages containing sugar more than once a week.

 

Abdominal obesity

Both diet and lifestyle factors such as screen media consumption and exercise can have an impact on the weight status and body composition of children (Olds et al., 2010). Abdominal obesity, the accumulation of fat in the abdominal region, is a risk factor for various non-communicable diseases and can be seen in childhood.

During a visit to the schools, the body composition of the children was objectively assessed - by means of height, weight and waist circumference.

At baseline, 7.8% of the participating children were abdominally obese, at follow-up 9.2% of children were classified abdominally obese.

The odds of developing abdominal obesity in the intervention group were less than half as great as in the control group. The variables with baseline differences between intervention and control group were initially included in the regression analysis, but did not show any significant influence on the result.

The longitudinal differences between WHtR and endurance performance showed a slight but significant opposite correlation, r = -0.075, n = 1700, p = 0.002.

 

For more details, see Kobel et al., 2019

 

 

Figure 8: Incidence abdominal obesity

The health promotion programme Join the Healthy Boat is a low-threshold approach that integrates health-related content into everyday curriculum and school life with clear, easily understandable messages and without additional specialist staff or teaching time.

In a scientific study (Baden-Württemberg Study), the effects of the programme on various health-related behaviours were investigated. Changes in the children's health behaviour (physical activity behaviour, dietary behaviour, screen media use) were assessed by the parents.

More than 80 % of parents who took part in the study provided information about these behaviours by returning a completed questionnaire. Parents reported a slight decrease in screen media use, especially among girls and those from families with lower educational levels; improved breakfast behaviour (fewer children skipping breakfast), especially among second graders; and a tendency towards more physical activity, especially among boys.

Other positive developments, such as less sugar-sweetened beverages and a more active travel to school, were also evident in classes that had not yet completed the programme. The frequency of overweight did not differ from the control group after one year, but endurance performance increased significantly.

The often positive changes in the control group are probably partly due to the large number of other health promotion programmes that were carried out in parallel in many classes, and show an increasing awareness of the topic.

A rethinking at the social level and changes in attitudes and behaviour at the individual level are the first steps towards making positive physical changes visible in the long term.