SUMMARY
An increase in the prevalence of obesity in children under the age of five has arisen in both the developed and developing countries of the world. A multi-faceted intervention designed to improve the body composition and physical fitness of preschool children in China showed significant promise. 357 children participants were tested and retested between September 2010 and August 2011. Compared to the control group, Chinese preschoolers improved several measures of body composition (body fat %, muscle mass) and made positive changes in several physical fitness measurements (30-meter sprint, broad jump, sit & reach). The multi-faceted intervention design included child care center interventions (teacher training, food services training, physical activity curriculum, & policy changes), family interventions (parent education, family events, internet website for support), and community interventions (playground renovation, community health promotion events).
Children were selected using a non-randomized study design with two conveniently selected childcare centers. Comparing the control group and the experimental group, the control group had less children across three grades (139) than the experimental group (218). The family income was significantly higher in control group children. Fathers of control children were more likely to be overweight and obese compared to fathers of intervention children. The study tried to match the control center’s demographics, quality of the facility, and teachers with the intervention center.
With a high fidelity rate (96.2%) to the protocols of the design and a high retention rate (95%), the measures taken to improve body composition and physical fitness were a success. Teachers had a 100% attendance to teacher trainings while parents had a 94% average rate of attendance to the four parent education events. Skills that were learned included design of age-appropriate physical activities, creating a safe play environment, controlling activity load and intensity, motivating children, and communicating and coordinating teaching activities with colleagues. The children showed leaps and bounds improvement over the course of one year by changing the protocols, level of engagement, and knowledge around the child.
DISCUSSION
Physical activity has a proportional relationship to health. On average, the experimental group exercised 254 minutes more a week than the control group. A high fidelity and retention rate kept preschoolers active, and accountable to the protocols of the design. Body composition changed drastically: body fat (- 1.2%, fat mass (- .55kg), body weight (- .36kg), and muscle mass (+ .48kg). Physical fitness tests showed improvement as well: 20-meter agility run (- 3.36 seconds), broad jump (+ 8.09cm), tennis ball throw (+ .52 meters), sit & reach (+ .88cm), balance beam walk (- 2.02 seconds), 20-meter crawl (- 3.36 seconds), 30-meter dash (- .45 seconds). According to the law of adaptation, it’s not surprising to see these results. I believe that with proper knowledge and implementation we can make positive changes in our community, schools, and in ourselves. The attendance rate of teachers and parents were notably high. Clearly they wanted their children to succeed at reducing body fat and increasing their physical fitness. All they needed was the methods to do so. A similar protocol could likely be used in the United States. I believe that physical activity is all about doing. An overweight individual who is active is healthier than a thinner individual who is inactive. To have the same results as the ones in this study across the nation would be incredible.
For the study, similar tables would have been helpful for reader analysis. Table 1 compares the study measurements during the baseline test. Children are categorized by their grade level, sex, and the number of children per category is neatly listed. All of the tested criteria (bf%, broad jump, etc.) were listed with the mean and standard deviation of the measurements for each category. Then in table 2, the mean and standard deviation at baseline and posttest are given for both the control and intervention group. Although it is clearly comprehensive, I would have preferred another table be organized the same way table 1 was in order to see differences in changes amongst males versus females, grade schools, and comparison to the control group. I believe that this could have given the reader a greater understanding of the susceptibility to weight loss, fitness levels, and better body composition for individuals. For example, comparing a control group of 139 control members versus 218 intervention members showed considerable differences. However, to compare a 1st grade girl to her previous measurement opposed to a 1st grade girl who was in the control group would be greater insight into the differences we might see if we compared a 1st grade boy in the intervention versus a 1st grade boy who was in the control group. Further, we can compare that same 1st grade girl to the 1st grade boy in the intervention, or all of the 1st, 2nd, and 3rd grade girls against the 1st, 2nd, and 3rd grade boys to see if one had a tendency to improve more. The only reason I am bringing this up is because they took down this same information for the girls and boys of both experiments but they didn’t categorize it in a way that could be most effectively compared for useful information. Also, when comparing the post test and baseline of the intervention group versus the control group the author didn’t specify whether drop outs and those who didn’t follow up were girls, boys, 1st graders, 2nd graders, etc. That could have been helpful for analysis.
For future studies of similar tests, I’d prefer a randomized selection of children. I saw flaws with the design of the study being a non-randomized selection of children. Matching the demographics, quality of facility, and quality of teachers still created a control group that had a significantly higher income, fathers who were more overweight or obese, and less members in the control group. Since the children were selected based on their day care center, the chance of income levels being higher because that day care center is more expensive could have been taken into account. Nonetheless the fathers were susceptible to weight gain, whether it was tied to their higher income or not. If there’s one thing this study can teach, it is that we are highly influenced by our environment. The experimental group was exposed to a more health conscious community, school, and set of parents for a whole year. It can be argued that a control group that was exposed to even one parameter (unhealthy parent) would increase rates of unfavorable body composition.
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