Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children’s BMI and energy balance-related behaviors – A systematic review

Background
The aims of this systematic review were to study the effectiveness of primary school-based physical activity, sedentary behavior and nutrition interventions with direct parental involvement on children’s BMI or BMI z-score, physical activity, sedentary behavior and nutrition behavior and categorize intervention components into targeted socio-cognitive determinants and environmental types using the Environmental Research framework for weight Gain prevention.
Methods
In March 2018, a systematic search was conducted in four electronic literature databases. Articles written in English about effectiveness studies on school-based interventions with direct parental involvement targeting 4–12 year olds were included. Interventions with indirect parental involvement, interventions not targeting the school environment, and pilot studies were excluded. Study and intervention characteristics were extracted. Study quality and study effectiveness were assessed and effect sizes (Cohen’s d) were calculated for the outcome measures. Types of socio-cognitive factors and environmental types targeted were distinguished.
Results
In total, 25 studies were included. Most studies on BMI or BMI z-score, physical activity and sedentary behavior found favorable results: 61.1%, 81.1% and 75%, respectively. Results regarding nutrition behavior were inconclusive. Methodological study quality varied. All interventions targeted multiple environmental types in the school and family environment. Five targeted socio-cognitive determinants (knowledge, awareness, attitude, self-efficacy and intrinsic motivation) of the children were identified. No consistent pattern was found between either type of environment targeted, number of type of environment targeted, or the child’s targeted socio-cognitive determinants and intervention effectiveness.
Discussion
School-based interventions with direct parental involvement have the potential to improve children’s weight status, physical activity and sedentary behavior. Based on the results, it is recommended that school-based interventions with direct parental involvement target more than one EBRB, last at least one year, and focus particularly on the physical and social environment within both the school and the family environment.

背景
本系统综述旨在探究纳入家长直接参与的、基于小学的身体活动、久坐行为与营养干预对儿童体重指数（Body Mass Index，BMI）、BMI z评分（BMI z-score）、身体活动水平、久坐行为及营养行为的干预效果，并基于《体重预防环境研究框架（Environmental Research framework for weight Gain prevention）》，将干预组件归类至靶向社会认知决定因素（socio-cognitive determinants）与环境类型中。

方法
本研究于2018年3月在4个电子文献数据库中开展系统检索。纳入以4~12岁儿童为靶向对象、纳入家长直接参与的学校干预效果研究的英文文献；排除纳入家长间接参与的干预、未靶向学校环境的干预以及预试验研究。提取研究与干预的特征信息，评估研究质量与干预效果，并计算结局指标的效应量（Cohen’s d）。明确靶向的社会认知因素类型与环境类型。

结果
最终共纳入25项研究。针对BMI或BMI z评分、身体活动与久坐行为的多数研究取得了积极效果，占比分别为61.1%、81.1%与75%；而针对营养行为的研究结果尚无定论。研究的方法学质量存在差异。所有干预均靶向学校与家庭环境中的多种环境类型，共明确了5项针对儿童的社会认知决定因素：知识、知晓、态度、自我效能感与内在动机。未发现靶向的环境类型、靶向环境类型的数量，或儿童靶向的社会认知决定因素与干预效果之间存在一致关联模式。

讨论
纳入家长直接参与的学校干预具备改善儿童体重状态、身体活动水平与久坐行为的潜力。基于本研究结果，建议纳入家长直接参与的学校干预应靶向至少1种EBRB，持续时长至少1年，并重点关注学校与家庭环境中的物理与社会环境。