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The Fueling Learning Through Exercise Study Cluster RCT: Impact on Children's Moderate-to-Vigorous Physical Activity

  • Jennifer M. Sacheck
    Correspondence
    Address correspondence to: Jennifer M. Sacheck, PhD, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington DC 20052.
    Affiliations
    Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia

    Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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  • Catherine M. Wright
    Affiliations
    Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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  • Sarah A. Amin
    Affiliations
    Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island
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  • Stephanie Anzman-Frasca
    Affiliations
    Center for Ingestive Behavior Research, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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  • Virginia M. Chomitz
    Affiliations
    Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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  • Kenneth K. Chui
    Affiliations
    Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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  • Paula J. Duquesnay
    Affiliations
    Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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  • Miriam E. Nelson
    Affiliations
    Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts

    The Newman's Own Foundation, Westport, Connecticut
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  • Christina D. Economos
    Affiliations
    Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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      Introduction

      Most children do not meet the recommendations for school-time and daily moderate-to-vigorous physical activity, with significant demographic disparities and declines over the elementary school years. Investigators examined the impact of Fueling Learning through Exercise study school-based physical activity programs on school-time and total daily moderate-to-vigorous physical activity among lower-income school children.

      Design, Participants, and Intervention

      Urban elementary schools (N=18) were cluster randomized to 100 Mile Club, Just Move, or control. Data collection and analyses occurred from 2015 to 2019 among third- and fourth-grade school children (N=1,008) across 2 academic years.

      Main outcome measures

      Student's moderate-to-vigorous physical activity was measured by 7-day accelerometry (Actigraph GT3X+) at baseline (before intervention), midpoint (6 months), and endpoint (18 months). Mixed-effects linear regression models examined program impact on school-time and daily moderate-to-vigorous physical activity, adjusting for clustering, demographics, weight status, free/reduced-price lunch eligibility, school physical activity environment, wear time, and weather. Program reach by sex, weight status, race/ethnicity, and baseline activity levels was explored.

      Results

      Of the 979 participants analyzed (aged 8.7 [SD=0.7] years, 44% male, 60% non-White, 40% overweight/obese, 55% eligible for free/reduced-price lunch), 8.4% (18.2 [SD=7.9] minutes per day) and 19.8% (45.6 [SD=19.4] minutes per day) fulfilled the 30-minute school-time and 60-minute daily moderate-to-vigorous physical activity recommendations at baseline, respectively. Overall, daily moderate-to-vigorous physical activity decreased from baseline to 18 months (p<0.001, −5.3 minutes, 95% CI= −8.2, −2.4) with no effect of programming. However, for school-time moderate-to-vigorous physical activity, intervention schools maintained school-time moderate-to-vigorous physical activity across the 2 academic years, whereas school-time moderate-to-vigorous physical activity decreased in control schools (p=0.004, −2.3 minutes, 95% CI= −4.3, −0.4). Program reach on school-time moderate-to-vigorous physical activity appeared equitable by sex and weight status but was different by race/ethnicity (p<0.001).

      Conclusions

      Two different school-based physical activity programs were effective in preventing the decline in school-time moderate-to-vigorous physical activity that is typical across the elementary years, with similar reach by sex and weight status. Multiple opportunities for physical activity during school are needed to promote meeting school-time moderate-to-vigorous physical activity recommendations among diverse children.

      Trial registration

      This study is registered at www.clinicaltrials.gov NCT02810834.
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