Centre of Research in Childhood Health. The Copenhagen School Child Intervention Study. CoSCIS

Transcription

1 The Copenhagen School Child Intervention Study. CoSCIS

2 Project design Schoolbased intervention, implemented by the municipality of Ballerup through Ballerups 10 commandments The municipality of Tårnby were selected as a controlgroup,since community statistisk, based on SES and distance to the center of Copenhagen, were similar to Ballerup 10 intervention schools, 8 control schools

3 Ballerup - plan of action: The 10 commandments 1. Extra PE lessons - a doubling of the amount from 2 to 4 lessons 2. Continuing education of PE teachers 3. Collaboration between teachers, students and parents on the childs development both on motor skills and physically (capability level) 4. A place to be physically active on an after school basis 5. A development of a body exploratorium with both theory, praksis and testing of skills 6. Upgrading of all indoor equipments 7. Renovation of all outdoor fascilities 8. Establishments of new outdoor fascilities where needed 9. Healthy food in school canteens 10. Ensure coorporation with after school sporting fascilities to enhance the childrens participation in sports on a free-will basis

4 The scientific purpose with CoSCIS were to create new and cross-functional knowledge about: Which physical, psykological and sociale relations that have a health enhancing effect on children age How the state of health in a common population of children, could be improved through a qualitative improvement and a quantitative enhancement of physical activity and education in health related issues. How integrated health promotion could be implemented in the best way possible in collaboration between municipality, schools and research institute.

5 Important steps in the scientific work: To clarify which longitudinal changes that leads to clustering of risk factors and obesity To find effective interventions that can be implemented on population level To find ways to reach the children with the lowest activity level/those who are in the worst physical form?

6 Schoolbased intervention studies Mandatory lessons in Physical Education(PE) Content Activity level Motivation Gives us an opportunity to reach the children at the lowest quartiles of physical activity and fitness levels

7 Design CoSCIS Controlled longitudinal schoolbased intervention from pre-school 3 th grade, followed by a 4 year follow-up. Intervention group and a control group No randomisation since Ballerup allready intented to carry out the intervention

8 The CoSCIS intervention A doubling of PE lesssons from 2 4 hours/week, from preschool til third class incl. All gyms and athletic fascilities were modernised All PE teachers were annually sent on a continuing education course in healthy living and diet and how to provide motivating PE lesson that enhances the enjoyment of being physically active Outdoor play fascilities were renovated during the intervention period Additionally, health related issues were incorporated in the generel education lessons through the intervention years An effort were made to implement healthy diets in school canteens

9 The aim of the scientific study: - To measure the effect of the intervention on the childrens physical and psykological health and well-being on different parameters, such as: Physiological/health-related parameters Personally and socially capabillities Motor performance skills Dietary intake

10 Study design Preschool class 2001/ th grade 2004/ th grade 2008/2009 Interventions periode Baseline measurements n= 706 Diet assessment n= 498 Measurements from 1. follow-up. n= 606 Diet assessment n= 423 Measurements from 2. follow-up. n= 513 Diet assessment n= 281

11 Recruitment of test subjects All children attending preschool in Ballerup and Tårnby in 2001 were invited to participate in the intervention (1024 children) Signed statement of consent from parent or guardian Testing was optional Possible to withdraw their signed statement of consent at any time

12 Test day: The children arrive fasting at the testroom at 8 AM Fasting bloodsampel were taken, followed by breakfast Bloodpressure, lung function, bone density, antropometric measurements, motor skills testing, and direct measured cardio-respiratory fitness test were measured Not all children in each class participated in our testing, therefore normal school day were maintained in classes

13 Fasting blood sampling Analyzede for: Fasting glucose level Fasting insulin level Cholesteroles (HDL, LDL) Triglycerides Cytokines (Adiponectin, Leptin, TNF-α, CRP, IL-1, IL-6)

14 Motor skill tests Consisting of: Backward balance Hopscotch Jumping laterally Shifting platforms Precision throw

15 Motor skill tests Consisting of : Backward Balance Hopscotch Jumping laterally Shifting platforms Precision throw

16 Motor skill tests Consisting of : Backward balance Hopscotch Jumping laterally Shifting platforms Precision throw

17 Motor skill tests Consisting of : Backward balance Hopscotch Jumping laterally Shifting platforms Precision throw

18 Motor skill tests Consisting of : Backward balance Hopscotch Jumping laterally Shifting platforms Precision throw

19 Physiological/medical tests Consisting of: Bloodpressure Lung function Bone density Epicondyl width Antropometric measures (height, weight, skinfold, bioimpedans, waist-hip) Treadmill test

20 Physiological/medical tests Consisting of: Blood pressure Lung function Bone density Epicondyl width Antropometric measures (height, weight, skinfold, bioimpedans, waist-hip) Treadmill test

21 Physiological/medical tests Consisting of: Blood pressure Lung function Bone density Epicondyl witdh Antropometric measures (height, weight, skinfold, bioimpedans, waist-hip) Treadmill test

22 Physiological/medical tests Consisting of: Blood pressure Lung function Bone density Epicondyl width Antropometric measures (height, weight, skinfold, bioimpedans, waist-hip) Treadmill test

23 Physiological/medical tests Consisting of: Blood pressure Lung function Bone density Epicondyl width Antropometric measures (height, weight, skinfold, bioimpedans, waist-hip) Treadmill test

24 Physiological/medical tests Consisting of: Blood pressure Lung function Bone density Epicondyl witdh Antropometric measurements (height, weight, skinfold, bioimpedans, waist-hip) Treadmill test

25 Additionally tests on testdays Puberty status self assessed by Tanner Questionary survey for both child and parent At baseline and 3 th grade both surveys were answered by the parents At 7 th grade the adolescent answered their survey on the test day and brought home the parental survey

26 Following tests Physical activity - measured by accelerometery for 7 consecutive days Diet assessment -7days registration of dietary intake

27 Insulin resistance HOMA score IL6 levels?? Fitness level Direct measured during a progressive treadmill running test Activity level Accelerometry assessments Fatness Sum of 4 skinfolds Hip/waist-ratio??

28 A study of the development of insulin resistance in relation to physical activity, aerobic fitness and overweight in children and youth. - The Copenhagen School Child Intervention Study. A 7-year controlled intervention study. Bianca El-Naaman Hermansen Supervisor: Lars Bo Andersen Funded by the Tryg Foundation

29 Aim: To investigate the development of insulin resistance in Danish schoolchildren in relation to physical activity, aerob fitness and level of fatness.

30 Hypothesis: That an intervention with enhanced physical activity, improved facilities, focus on healthy living and continous education of PE teachers will contribute to: a change in lifestyle that will improve insulin sensitivity in muscle cells, which will positively affect appetite regulation, the risk of developing obesity, and lower the levels of risk factors for type 2 diabetes. an enhanced motivation of being physically active which, in the long term, will contribute to a reduktion in the number of children with an impaired metabolic profile.

31 Working titels 1. Insulin resistance and measurements of fatness and fitness among school-aged children. CoSCIS 2. Does physical activity, fitness or fatness predict insulin resistance in year Old Danish children? CoSCIS. 3. Long term effects of a school-based intervention on development of risk factors for type 2 diabetes. CoSCIS.

32 1. Insulin resistance and measurements of fatness and fitness among school-aged children. CoSCIS. Correlations between insulin resistance and measurements of fitness and fatness on baseline and over time from baseline 2. follow-up. Insulin resistance: HOMA score Fitness: direct progressive treadmill test Fatness: sum4skin Description of the population Reference for later discussion of secular trends

33 2. Does physical activity, fitness or fatness predict insulin resistance in year Old Danish children? CoSCIS. Cross sectional study of 7th graders Insulin resistance: HOMA score Activity : accelerometry Fitness: direct progressive treadmill test Fatness: sum4skin Is it possible that the activty level, fitness level and/or the level of fatness can predict insulin resistance in the population??

34 3. Long term effects of a school-based intervention on development of risk factors for type 2 diabetes. CoSCIS. Mainfocus: The effect of an early schoolbased intervention on the development of risk factors over time Allso investigate if there is a different effect of the intervention if we split the children in different levels of fitness and fatness maybe only look at the lower quintiles Insulin resistance: HOMA score IL6?? Physical Fitness: direct progressive treadmill test Fatness: sum4skin Maybe look into the level of IL6 and if there is a relation between the developments of IL6 resistance and insulin resistance

35 Thank you